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Text File  |  1993-09-19  |  2KB  |  56 lines
  1.     (This form is provided for your convenience; it isn't required)
  2.  
  3.  
  4.     Name: ____________________________________________________________
  5.  
  6.  
  7.     Address: _________________________________________________________
  8.  
  9.  
  10.              _________________________________________________________
  11.  
  12.  
  13.              _________________________________________________________
  14.  
  15.  
  16.     =====Fido Nodes Only=====
  17.     Fidonet Address:         _________________________________________
  18.  
  19.     Do you want to Freq the registration from 1:380/16?      [ Y / N ]
  20.  
  21.     Session Password:        _________________________________________
  22.     ==================================================================
  23.  
  24.  
  25.     Where you got FM: ______________________________ Version: ________
  26.  
  27.  
  28.     Preferred media:                ___ 5-1/4"               ___ 3-1/2"
  29.  
  30.  
  31.       _____ personal-use registration(s)    X    $35.00 ea. US
  32.  
  33.       _____ commercial-use registration(s)  X    $75.00 ea. US
  34.  
  35.       _____ shipping outside continental US X    $ 5.00 ea. US
  36.                                                  -------------
  37.  
  38.       _____ total registrations                 $__________ US enclosed
  39.  
  40.  
  41.     Commments/Suggestions (include separate sheet if desired):
  42.  
  43.  
  44.     _________________________________________________________________
  45.  
  46.  
  47.     _________________________________________________________________
  48.  
  49.  
  50.     _________________________________________________________________
  51.  
  52.  
  53.     Mail to:                  Mark Kimes
  54.                               542 Merrick
  55.                               Shreveport, LA  USA  71104
  56.