n individual) CLASS A MEMBER CLASS A MEMBER Ontp Oa 911a1 (name of entity) Print Name: Print address: By: Name: o ‘J Gt. e.../S Title: fro n%Ic5 rc C raPe- ,Er* address: 3Lc:=1 ca-kxeeze Poo- ' i ldry‘ -1)1Fieb TIN: 71-1 tt_o 1?-iPt Acknowledged and agreed to effective as of 12012: MIDWAY-