Make checks payable to:    Colorado Chili Pod

Applicant                   Spouse/Significant Other

Name_______________________________  Name_______________________________

Address____________________________  Address____________________________

___________________________________  ___________________________________

Home Phone_________________________  Home Phone_________________________

Work Phone_________________________  Work Phone_________________________

Occupation_________________________  Occupation_________________________

Employer___________________________  Employer___________________________

Fax #______________________________  Fax #______________________________

E-Mail_____________________________  E-Mail_____________________________

Birthdate__________________________  Birthdate__________________________

Chili Team_________________________  Chili Team_________________________

Signatures

Applicant                           Spouse/Significant Others

___________________________________  ___________________________________

Date_______________________________  Date_______________________________

Mail to:    Colorado Chili Pod
            c/o John Montgomery
            1600 Broadway, Suite 2500
            Denver, Colorado 80202-4925

For Information:    Lyman Wilkinson at (970)669-1573 (hm - telephone)

John Montgomery at (303) 831-5000 (wk - telephone) (303) 831-5032 (wk - fax) e-mail: coloradochili@aol.com