Note:

Number of Items in Batch
(right justified, zero filled)

Total Shares in Batch

(right justified, zero filled)

Total Extended Contract Amount in Batch

(right justified, zero filled, no punctuation) NNNNNNNNNNNN

Blank - Not Used

TOTAL SHARES and AMOUNT are not applicable for Advisory data.

2

2

XMOTCY

THE ABOVE UNCOMPARED ITEM WAS SUBMITTED TO NCC HY "SELLER" INDICATING YOU AS PURCHASER.
TO ADD THE ABOVE ITEM

1. IMPRINT YOUR NAME & NUMBER STAMP
ON COPIES 1 & 2

2. RETURN COPIES 1 & 2 IN ACCORDANCE
WITH NCC RULES

3. KEEP COPY 3 AS YOUR RECORD OF ADD
DO NOT ERASE OR CHANGE PRINTED DATA

NCC 25 REV 10-71

1

INSTRUCTIONS TO NCC

ADD THE ABOVE ITEM EXACTLY AS PRINTED TO OUR PURCHASE CONTRACT LIST.

PURCHASER'S NAME & NUMBER STAMP

THE ABOVE UNCOMPARED ITEM WAS SUBMITTED TO NC BY TURCHASER" INDICATING YOU SELLEK
TO ADD THE ABOVE ITEM

1

INSTRUCTIONS, TO NCC

ADD ABOVE 11 MEXACTLY AS PRINTE O TO OUR SALE CONTRACT LIST.

SELLER'S NAME & NUME I STAMP

EXHIBIT G

Date

NCC MEMBERSHIP SURVEY

Please answer all questions and return by August 15, 1972.

4.

5.

If you do not have a NASDAQ Market Maker Symbol, request one (must be four alpha characters) and NCC will confer with NASD/NASDAQ and confirm this assignment to you.

Selection:

Indicate the location(s) at which you wish to submit trade data (check as many as desired). This determines where your contract lists will be made available.

New York
Philadelphia

Boston

Indicate the location with which you wish to Settle your trades (Check only one):