AT ANY FALSE OR DISHONEST ANSWER TO ANY QUESTION MAY RI GROUNDS FOR DENIAL OR SUISICHANTREVOCADON CF REGISTRATION. TREASURER PRESIDENT SIGNATURE FeRvaid HeM DATE SCNATLRE Men E. ERNS DATE RENTED FIRST NAME AND LAST NAME PRINTEDMST NAME NC LAST NAME EFTA00284835 Nautilus, Inc EIN # 66-0776990 BA