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Registration Form

Registration form for DeliPlayer
Program No.: 131302
Last name:
First name:
Company:
Street and #:
City, State, postal code:
Country:
Phone:
Fax:
E-Mail:

** Please do not forget to include your e-mail address. ***
** We will use e-mail to communicate with you. ***


How would you like to pay the registration fee (check one):

\fbox{\rule{2mm}{0mm}\rule{0mm}{2mm}} Credit Card
\fbox{\rule{2mm}{0mm}\rule{0mm}{2mm}} Wire Transfer
\fbox{\rule{2mm}{0mm}\rule{0mm}{2mm}} EuroCheque
\fbox{\rule{2mm}{0mm}\rule{0mm}{2mm}} Cash


Credit card information (if applicable)
Credit card: Visa - Eurocard/Mastercard - American Express - Diners Club
Card holder:
Card No.: Expiration Date:
Date / Signature:
next up previous contents
Next: Frequently Asked Questions Up: DeliPlayer documentation Previous: Registration   Contents
2000-11-26