Reprint Order Form

Please send to:
		Name_______________________________

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Copies requested:

	Volume #      |     Page #	|	# of Pages
        ______________|_________________|___________________
                      |                 |
        ______________|_________________|___________________
                      |                 |   
        ______________|_________________|___________________
                      |                 |
        ______________|_________________|___________________
                      |                 |
        ______________|_________________|___________________
                      |                 |
        ______________|_________________|___________________

                              Total # of pages _____________
                              Cost per page __________X  .25

                              Sub-total_____________________
                              Add handling and shipping_2.50

                              Total_________________________

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                        STATEMENT OF USE

          I hereby certify that any reprints that I order from 
R. L. Hack, will be used for private study or research by my-
self, as intended by Sec. 2(a) of the Copyright Act of Canada.
R. S. c55, s.1.

          Furthermore, should I violate the Copyright Act, I
will indemnify R. L. Hack.



Signed_____________________________

Date_______________________________