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Text File  |  1999-10-03  |  2KB  |  84 lines
  1.  
  2.  
  3. Image Engineer Registration Form
  4. --------------------------------
  5.  
  6.  
  7.  
  8.  Name:              _____________________________________________
  9.  
  10.  
  11.  Address:           _____________________________________________
  12.  
  13.                     _____________________________________________
  14.  
  15.                     _____________________________________________
  16.  
  17.  Country:           ______________
  18.  
  19.  
  20.  Age:               __________
  21.  
  22.  Status:            _____________________________________________
  23.  
  24.  
  25.  Email:             _____________________________________________
  26.  
  27.  Website:           _____________________________________________
  28.  
  29.  
  30.  
  31.  I've attached with this Registeration Form:
  32.  (including possible extra fee for postal costs)
  33.  
  34.    O  Cash - _____ ( FIM / EUR / DM )
  35.  
  36.    O  A receipt of bank transfer - _____ ( FIM / EUR / DM )
  37.  
  38.  
  39.  
  40.  Method of sending the keyfile:
  41.  
  42.    O  By email using emailaddress above
  43.  
  44.    O  On diskette to be delivered by post office
  45.       (I've included specified extra fee for postal costs)
  46.  
  47.  
  48.  
  49.  Version of Image Engineer: ______
  50.  
  51.  
  52.  I got this version of Image Engineer from:
  53.  
  54.  ________________________________________________________________
  55.  
  56.  
  57.  First time I heard about Image Engineer was:
  58.  
  59.  ________________________________________________________________
  60.  
  61.  ________________________________________________________________
  62.  
  63.  
  64.  My system configuration:
  65.  
  66.  ________________________________________________________________
  67.  
  68.  ________________________________________________________________
  69.  
  70.  ________________________________________________________________
  71.  
  72.  
  73.  
  74.  I fully understand that the keyfile I will receive is only for
  75.  my personal use. I won't give it away or make any copies of it.
  76.  
  77.  
  78.  
  79.  
  80.  __________________________         _____________________________
  81.  City, Date                         Signature
  82.  
  83.  
  84.