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Text File  |  1996-07-15  |  1KB  |  59 lines
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  11.         To:                            Please register me for "CxBar"
  12.         Thomas Igracki
  13.         Siegener Str. 34
  14.         13583 Berlin
  15.         Deutschland
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  24. FirstName:                            Name:                               
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  26.    Street:                                                                  
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  28.  ZIP,City:                                      Country:                    
  29.            ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯          ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
  30.     EMail:                                        Phone:                    
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  34.  Payment by: [ ] Cash (please don't send coins)
  35.                  [ ] $10 (US dollar)
  36.                  [ ] 10 DM (Deutsche Mark)
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  38.              [ ] Money transfer of 10 DM to this account:
  39.                    Thomas Igracki
  40.                    Sparkasse Berlin
  41.                    Account 860 169 138
  42.                    BLZ 100 500 00
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  44.                  Write a litte note (who you are etc) on the transferformular!
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  48.  Comment: 
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  54.    ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯         ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
  55.             (City, Date)                           (Signature)
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  58. Thank you for registering CxBar!
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