SUBSCRIPTIONS 

Please send me:
1 x 12 months subscription   @ $150 = $ ____
1 x  6 months subscription      @ $80 = $ ____
___ x ___ back issue #  @ $14.95 ea = $ ____
                                                             Total ____
Name:_____________________________________________
(credit card payments - list name as appears on card)
Address: ___________________________________________
________________________________Postcode:___________ 
(Credit card payments - list home address, not business or PO box)
Phone:  (BH)_________________  (AH)___________________
Email:______________________________________________
Please charge my (tick) ____Mastercard  ____Visa  ____Bankcard
Credit card number: __ __ __ __  __ __ __ __  __ __ __ __  __ __ __ __
Card valid from:  ___ /___ to ___ /___  
Signature:______________________

Please make cheques payable to: Robot Madness Pty Ltd
Send payment and this form to: 
		
		THE DISC SUBSCRIPTIONS
                ROBOT MADNESS 
                LEVEL 2, 11-17 DORCAS STREET
                SOUTH MELBOURNE VIC 3205
                Fax: 03/ 9690 8337