Please check one box. Check box A. Initial Submission (for a new application); Check box B. • Revision (if you need to correct an error on a previously submitted form); Check C. 5‐year • Renewal (if your form has expired, and you need to renew it). • 2 – Your company information: • o 2A – Company Name • o 2B – Address (include both physical address & PO Box (if applicable)) • o 2C – Name of Subsidiary, Division or Department (if applicable) • o 2D – Cage Code (this is the number you’ll receive from XXX) • 3 – Data Custodian (this is the person who will be responsible for the form & is usually a security • person, export control person, etc.) • o 3A‐D all the information for this person DD2345 7 DD2345 FRONT SECTION 1-3 • 4 – Include relevant business activity: Note: this is the most critical part of your request. • Provide a concise and detailed description of Entity's (listed in Block 2a) Business Activity. This will assist the Canadian or U.S. Government agency controlling the data in determining whether the DOD unclassified controlled technical data that you might request is reasonably related to your stated business activity.
Please check one box o The undersigned agrees that the Warrants shall be exercised by "cashless exercise" pursuant to the terms of the Warrants. o The undersigned encloses payment of the aggregate exercise price of the Warrants in full by check. The undersigned acknowledge(s) receipt of the Offer to Purchase dated November 26, 2002 and the Schedule 14D-9 Solicitation/Recommendation Statement in connection with the Offer by Purchaser. The undersigned further acknowledges that he or she has been advised that (i) MDI and Scientific Games International, Inc. will make it possible for Warrant Shares issuable upon exercise of the Warrants covered by Warrant Elections above to be tendered in the Offer, and (ii) upon the purchase of Warrant Shares pursuant to this Warrant Election, the undersigned shall have no further rights under such Warrant. Number of Warrant Shares to be Tendered:* Warrants held and Warrant Exercise Prices: Warrant Holder: Dated: Signature Print Name Address Area Code and Telephone Number Tax ID or Social Security Number * Unless otherwise indicated, it will be assumed that all Warrant Shares will be tendered.
Please check one box o The undersigned agrees that the Options shall be exercised by the "net exercise" method and instructs the Company to withhold from the Option Shares that would otherwise be issued upon exercise that number of Option Shares having a fair market value equal to the aggregate Option exercise price. o The undersigned encloses payment of the aggregate exercise price of the Options in full by check. The undersigned acknowledge(s) receipt of the Offer to Purchase dated November 26, 2002 and the Schedule 14D-9 Solicitation/Recommendation Statement in connection with the Offer by Purchaser. The undersigned further acknowledges that he or she has been advised that (i) Options for which a valid Option Election form has been executed and delivered to MDI that are not already vested will become vested immediately prior to the closing of the Offer (but contingent upon the anticipated purchase by Purchaser of shares of Common Stock pursuant to the Offer), (ii) MDI and Scientific Games International, Inc. will make it possible for Option Shares issuable upon exercise of the Options covered by Option Elections above to be tendered in the Offer, and (iii) upon the purchase of Option Shares pursuant to this Option Election, the undersigned shall have no further rights under such Option. Number of Option Shares to be Tendered:* Options held and Option Exercise Prices: Aggregate Exercise Price: Option Holder: Dated: Signature Print Name Address Area Code and Telephone Number Tax ID or Social Security Number *
Please check one box. I am not a member of any Corporation or Government organization enrolled in the Zatzman Sportsplex Corporate Rate Program. I am a member of a Corporation or Government organization enrolled in the Zatzman Sportsplex Corporate Rate Program. *Corporate or Government Department Name: __________________________________ *Verification of employment (Employee Signature): ________________________________ Release The undersigned acknowledges that all workouts and/or activities performed at the Zatzman Sportsplex will be solely at his or her own risk and hereby releases and discharges the Sportsplex, staff and employees from any liabilities, claims, demand, injury, damage, action or cause of action, whatsoever, which may result from the use of the services or facilities of the Zatzman Sportsplex. We recommend that before beginning a new fitness or activity program persons consult with their physician. Member’s Name (PRINT): ________________________________ Member #: ____________ Member’s Signature: ____________________________________ Date: ________________ My signature above indicates my agreement to the terms and conditions above. If member is under 18 years of age, parent or guardians’ signature: ____________________________ Type of Membership Adult_____ Family_____ Senior_____ Youth______ Student_____Promo_____
