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/ Monster Media 1996 #15 / Monster Media Number 15 (Monster Media)(July 1996).ISO / spitfire / sfq10.zip / REGISTER.TXT < prev    next >
Text File  |  1996-04-06  |  5KB  |  59 lines
  1. +----------------------------------------------------------------------------+
  2. |                      -*-  SFQ Registration Form -*-                        |
  3. +----------------------------------------------------------------------------+
  4. |                                                                            |
  5. |  Send to:  Eldon Martin                       The Data Sector BBS          |
  6. |            HCR 75 Box 99                      (717) 485 - 5914             |
  7. |            McConnellsburg, PA  17233          SFNET Node A0717008          |
  8. |                                                                            |
  9. |  Registration fee is $10  (PA residents add 6% sales tax)                  |
  10. |  Foreign orders use international money order payable in U.S. funds        |
  11. +----------------------------------------------------------------------------+
  12. |                                                                            |
  13. | Name___________________________________________________                    |
  14. |                                                                            |
  15. | Street Address_________________________________________                    |
  16. |                                                                            |
  17. | City___________________________ State_____ ZIP_________                    |
  18. |                                                                            |
  19. | BBS Name_______________________________________________                    |
  20. |                                                                            |
  21. | BBS Phone Number_______________________________________                    |
  22. |                                                                            |
  23. | BBS Software___________________________________________                    |
  24. |                                                                            |
  25. +----------------------------------------------------------------------------+
  26. |                                                                            |
  27. | [ ] Send the registered version by U.S. Mail                               |
  28. |                                                                            |
  29. | [ ] I'll download the registered version from The Data Sector BBS          |
  30. |                                                                            |
  31. |     [ ] I already have an account                                          |
  32. |                                                                            |
  33. |     [ ] Set up my account with the following information:                  |
  34. |                                                                            |
  35. |         First __ __ __ __ __ __ __ __ __ __ __        (No aliases allowed) |
  36. |                                                                            |
  37. |         Last __ __ __ __ __ __ __ __ __ __ __                              |
  38. |                                                                            |
  39. |         Password __ __ __ __ __ __ __ __ __ __                             |
  40. |                                                                            |
  41. |         Birthdate __ __ / __ __ / __ __                                    |
  42. |                                                                            |
  43. +----------------------------------------------------------------------------+
  44. |                                                                            |
  45. | Questions or comments:                                                     |
  46. |                                                                            |
  47. | _________________________________________________________________________  |
  48. |                                                                            |
  49. | _________________________________________________________________________  |
  50. |                                                                            |
  51. |                                                                            |
  52. | Suggestions for future projects:                                           |
  53. |                                                                            |
  54. | _________________________________________________________________________  |
  55. |                                                                            |
  56. | _________________________________________________________________________  |
  57. |                                                                            |
  58. +----------------------------------------------------------------------------+
  59.