home *** CD-ROM | disk | FTP | other *** search
/ Monster Media 1996 #14 / Monster Media No. 14 (April 1996) (Monster Media, Inc.).ISO / educate / musq252.zip / ORDER.FRM < prev    next >
Text File  |  1996-01-30  |  1KB  |  52 lines
  1. MUSICAL TERMS QUIZZER
  2. REGISTRATION ORDER FORM
  3.  
  4. (please fill all the information below and print neatly)
  5.  
  6. NAME                    ___________________________________________
  7.  
  8. BBS NAME                ___________________________________________
  9.  
  10. MODEM NUMBER            ___________________________________________
  11.  
  12. HOME PHONE              ___________________________________________
  13.  
  14. WORK PHONE              ___________________________________________
  15.  
  16. FAX NUMBER              ___________________________________________
  17.  
  18. EMAIL ADDRESS           ___________________________________________
  19.  
  20.  
  21. MAIL ADDRESS            ___________________________________________
  22.  
  23.                         ___________________________________________
  24.  
  25. CITY                    ___________________________________________
  26.  
  27. PROVINCE/STATE          ___________________________________________
  28.  
  29. POSTAL/ZIP CODE         ___________________________________________
  30.  
  31. COUNTRY                 ___________________________________________
  32.  
  33.  
  34.  
  35. PLEASE SEND THE REGISTRATION KEY BY:
  36. (please check only one)
  37.  
  38. [    ]  MAIL            [    ]  EMAIL           [    ]  VOICE PHONE
  39. [    ]  FAX
  40.  
  41.  
  42. THANK YOU FOR COMPLETING THIS FORM!
  43.  
  44. ACCOMPANIED BY $12 IN CANADIAN FUNDS, MAIL FORM TO:
  45.  
  46.                 ANDREW SHERK
  47.                 R. R. #1
  48.                 VERONA, ONTARIO
  49.                 K0H 2W0
  50.                 CANADA
  51.  
  52.