(Please print clearly. It is very important for me to be able to clearly read your email address!)

Name:                                                                                             

Address:                                                                                        

City:                                State:               Zip:                                 

Country:                                                                                        


Email Address:                                                                            

Other Email Address:                                                                 


Quantity          Price  (each)        Total

                  X     $10.00        =  $               


For all NON-USA orders:  Please make sure to only pay with US Currency or a Money Order.

Questions/Comments?  Send email to:  inaka@cap.or.jp

Send Computer Cuisine Form & Payment to:

Mike McGee 
Toyama-Ken, Nei-Gun
Yatsuo-Machi, Ida 6742
Ayumi So #306                                                           Click On The Box Above!
Japan  939-23

(When this form is completed & mailed, you will be emailed the registration password. If you do not have an email account, the password can be sent by Overseas/US Mail.)