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  1.               __     __          ____    __    ____    ____
  2.               \ \   / /         / _  \  /  \  /    \  /    \
  3.                \ \ / /   ____  / / \_/ / / / /     / /     /
  4.                 > X <   /___/  \ \_   / / / / / / / / / / /
  5.                / / \ \          \  / /   / / / / / / / / /
  6.               /_/   \_\          \/  \__/ /_/_/_/ /_/_/_/
  7.  
  8.  
  9.                          +-------------------+
  10.                          | REGISTRATION FORM |
  11.                          +-------------------+
  12.    _   _   _   _   _   _  _   _   _   _   _   _   _   _   _   _   _   _
  13. \_/ \_/ \_/ \_/ \_/ \_/ \/ \_/ \_/ \_/ \_/ \_/ \_/ \_/ \_/ \_/ \_/ \_/ \_/
  14.  
  15.           Name :
  16.                 ------------------------------------------------------
  17.  
  18.        Address :
  19.                 ------------------------------------------------------
  20.  
  21.                 ------------------------------------------------------
  22.  
  23.                 ------------------------------------------------------
  24.  
  25.                 ------------------------------------------------------
  26.  
  27.        Country :
  28.                 ------------------------------------------------------
  29.  
  30.  EMail Address :
  31.                 ------------------------------------------------------
  32.  
  33.  Computer Type :
  34.                 ------------------------------------------------------
  35.  
  36.     Modem Type :
  37.                 ------------------------------------------------------
  38.  
  39.  Kickstart Ver :
  40.                 ______________________________________________________
  41.  
  42.            CPU : 
  43.                 ______________________________________________________
  44.  
  45.       Comments :
  46.                 ------------------------------------------------------
  47.  
  48.                 ------------------------------------------------------
  49.  
  50.                 ------------------------------------------------------
  51.  
  52.                 ------------------------------------------------------
  53.  
  54.                 ------------------------------------------------------
  55.  
  56.         Note:   The following space allows you to specify an login username
  57. and password on the X-Comm Support BBS for upgrades and latest information.
  58.  
  59.   Account Name :
  60.                 ------------------------------------------------------
  61.  
  62.       Password :
  63.                 ------------------------------------------------------
  64.  
  65. ======================================================================
  66.  
  67. Payment:
  68. --------
  69.  
  70.         Fee                                                Please tick
  71.         --------------------------------------------------------------
  72.  
  73.         Registration Fee  ($A45)                                  ____
  74.  
  75.         Post & Handling within Australia ($A5)   \                ____
  76.                                                Only tick one.
  77.         Post & Handling outside Australia ($A10) /                ____
  78.  
  79.                                                                   ====
  80.  
  81.                                                   Total        _______
  82.  
  83.         NOTE: All disks returned will be Australia Post Registered.
  84.  
  85.         --------------------------------------------------------------
  86.  
  87. Method of Payment:
  88. ------------------
  89.  
  90.         Type                                               Please tick
  91.         --------------------------------------------------------------
  92.  
  93.         Cash (Australian Dollars ONLY)                         _______
  94.  
  95.         Bank Cheque     (In Australian Dollars ONLY)           _______
  96.  
  97.         Australia Post Money Order                            
  98.         or Money Order in Australian Dollars.                  _______
  99.  
  100.         (Basically, anything that is Australian Dollars will most likely
  101.         be accepted)  NO CHEQUES.
  102.  
  103.         ----------------------------------------------------------------
  104.  
  105.         I  have  read  the license and distribution details, and agree with
  106. them.
  107.  
  108.  
  109.         Date :                           Signature :
  110.               --------------------                  --------------------
  111.    _   _   _   _   _   _  _   _   _   _   _   _   _   _   _   _   _   _
  112. \_/ \_/ \_/ \_/ \_/ \_/ \/ \_/ \_/ \_/ \_/ \_/ \_/ \_/ \_/ \_/ \_/ \_/ \_/
  113.  
  114.                                                                 Thank You
  115.  
  116. ---------------------------------> CUT HERE <---------------------------
  117.  
  118. Please send this form and the appropriate payment to :
  119.  
  120.                 Edward Lawford
  121.                 27 Mosman Street
  122.                 Mosman, 2088,
  123.                 NSW,
  124.                 Australia
  125.  
  126. Please make all money payable to "X-Comm Development Team"
  127.