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/ Monster Media 1994 #2 / Monster Media No. 2 (Monster Media)(1994).ISO / soundu / modcom21.zip / REGIST.FRM < prev    next >
Text File  |  1994-04-05  |  2KB  |  44 lines
  1.  
  2.         Registration Form:
  3.  
  4.                 Mail this to..  Brett Lucey
  5.                                 29 Old Nourse St
  6.                                 Westborough, MA, 01581-3542
  7.  
  8.         Name: _____________________________________________
  9.  
  10.         BBS/Organization: _________________________________
  11.  
  12.         Alias: ____________________________________________
  13.  
  14.         Address: __________________________________________
  15.  
  16.                  __________________________________________
  17.  
  18.                  __________________________________________
  19.  
  20.         BBS Phone Number:  (__ __ __)__ __ __ - __ __ __ __
  21.         
  22.         Voice Phn Number:  (__ __ __)__ __ __ - __ __ __ __
  23.                                                           
  24.         Method Of Payment: (Check Off) |__| CASH |__| CHECK 
  25.  
  26.                 Please make checks payable to Brett Lucey!!
  27.         If you send LESS than $15, I will consider it a 
  28.         donation, and the money will not be returned, and
  29.         MODCOM will not be send!
  30.  
  31.         Disk Size:  |__| 360k |__| 720k |__| 1.2m |__| 1.4m
  32.  
  33.         Comment Lines: ___________________________________
  34.  
  35.                        ___________________________________
  36.                        
  37.                        ___________________________________
  38.  
  39.                        ___________________________________
  40.  
  41.                        ___________________________________ 
  42.                        
  43.                        ___________________________________
  44.