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Text File  |  1996-04-07  |  1KB  |  54 lines
  1. HERE REGISTRATION FORM
  2.  
  3. The registration fee for Here is $10 US.  You may pay by
  4. check or credit card.
  5.  
  6. Your Name:
  7.  
  8. ______________________________________________________
  9.  
  10. Your Postal Address:
  11.  
  12. ______________________________________________________
  13.  
  14. ______________________________________________________
  15.  
  16. Your Email Address:
  17.  
  18. ______________________________________________________
  19.  
  20. If paying by credit card:
  21.  
  22. Cardholder's Name:
  23.  
  24. ______________________________________________________
  25.  
  26. Card's Issuer (check one):
  27.  
  28. ___Visa ___Mastercard ___Discover
  29.  
  30. Card Number:
  31.  
  32. ______________________________________________________
  33.  
  34. Card's Expiration Date:
  35.  
  36. ______________________________________________________
  37.  
  38. Cardholder's Signature:
  39.  
  40. ______________________________________________________
  41.  
  42. Please complete and mail this form, together with your check
  43. or the above credit card information, to:
  44.  
  45. Everitt Beers
  46. 8928 Beverlywood Street
  47. Los Angeles, California 90034-2418 USA
  48.  
  49. If paying by credit card, you can instead email this form to:
  50.  
  51. beers@cris.com
  52.  
  53. Thank you for your support!
  54.