Block · one region of the page, as the scanner read it. It may hold a whole story, part of one, several, or an advertisement; stitching blocks into articles is the next step. Text is supplied OCR.

Page 4 · column 2 of 3 · from the scan, no model involved

The clipping this text was read from
The clipping this text was read from

BLUE CROSS

65 EXTENDED

Husband and wife must file separate applications

BLUE SHIELD PLEASE PRINT PLEASE PRINT

I wish to enroll as a Subscriber for the prepaid health care services offered by Virginia Hospital Service Association and Virginia Medical Service Association under the 65 Extended Contract. My Social Security Number_ Birth Month-Year_ □ Male Q Female Name: □ Miss □ Mrs.

□ Mr. -'_,_

(first name) (middle initial) (last name) Addressr

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