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Text File  |  1993-05-01  |  4KB  |  54 lines
  1.  
  2.      ------------------------------------------------------------------------
  3.      [                         Registration Form                            ]
  4.      [                                                                      ]
  5.      [   Date: __________                    TO:  Ralph LoBianco            ]
  6.      [                                            Suite #231                ]
  7.      [                                            7143 State Road 54        ]
  8.      [                                            New Port Richey, FL 34653 ]
  9.      [                                                                      ]
  10.      [   FROM:     Name: ________________________________________           ]
  11.      [                                                                      ]
  12.      [          Address: ________________________________________           ]
  13.      [                                                                      ]
  14.      [                   ________________________________________           ]
  15.      [                                                                      ]
  16.      [                   ________________________________________           ]
  17.      [                                                                      ]
  18.      [     BBS Name ______________________________________________          ]
  19.      [                                                                      ]
  20.      [     Modem Type/Max Baud Rate ______________________________          ]
  21.      [                                                                      ]
  22.      [     BBS Phone # (_____)_________________________                     ]
  23.      [                                                                      ]
  24.      [     Voice Phone # (_____)_______________________                     ]
  25.      [                                                                      ]
  26.      [   PROGRAM NAME:______________  VERSION:___________________           ]
  27.      [                                                                      ] 
  28.      [   WHERE DID YOU GET IT: __________________________________           ]
  29.      [                                                                      ]
  30.      [   IF BBS, NAME & PHONE: __________________________________           ]
  31.      [                                                                      ]
  32.      [   COMMENTS:_______________________________________________           ]
  33.      [                                                                      ]
  34.      [   ________________________________________________________           ]
  35.      [                                                                      ]
  36.      [   ________________________________________________________           ]
  37.      [                                                                      ]
  38.      [   ________________________________________________________           ]
  39.      [                                                                      ]
  40.      [   ________________________________________________________           ]
  41.      [                                                                      ]
  42.      [                                                                      ]
  43.      [             SETED  Registration Fee....... _ $5.00___                ]
  44.      [                                                                      ]
  45.      [             FL residents add sales tax .... __________               ]
  46.      [                                                                      ]
  47.      [             Total Enclosed ................ __________               ]
  48.      [                                                                      ]
  49.      [                                                                      ]
  50.      [         Please DO NOT send cash.  Send check or money order.         ]
  51.      ------------------------------------------------------------------------
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