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Text File  |  1992-02-29  |  2KB  |  42 lines
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  8.         ┌─────────────────────────────────────────────────────────────┐
  9.         │                                                             │
  10.         │               A2Z DATE  Registration Form                   │
  11.         │                                                             │
  12.         │            Mail to:  Clark Waggoner                         │
  13.         │                      603 S. Adams                           │
  14.         │                      Sapulpa, OK 74066                      │
  15.         │                      (918) 227-1611                         │
  16.         │                                                             │
  17.         │   Name                                                      │
  18.         │        ───────────────────────────────────────────────      │
  19.         │                                                             │
  20.         │   Address                                                   │
  21.         │           ────────────────────────────────────────────      │
  22.         │                                                             │
  23.         │   City                       State         Zip              │
  24.         │        ─────────────────────       ───────     ───────      │
  25.         │                                                             │
  26.         │   Phone                                                     │
  27.         │         ───────────────────────────                         │
  28.         │                                                             │
  29.         │   # of Non-commercial Registrations            @ $3.00      │
  30.         │                                    ───────────              │
  31.         │                                                             │
  32.         │   # of Commercial Registrations                @ $5.00      │
  33.         │                                    ───────────              │
  34.         │                                                             │
  35.         │   Amount included  $                                        │
  36.         │                      ─────────────────────                  │
  37.         │    Make checks to: Clark Waggoner                           │
  38.         │    Add $5.00 for copy of latest version.                    │
  39.         │    Orders under $10.00 include SASE if you wish a receipt.  │
  40.         └─────────────────────────────────────────────────────────────┘
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