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Text File  |  1996-01-05  |  4KB  |  60 lines
  1.    +----------------------------------------------------------------+
  2.    |                      REGISTRATION FORM          |              |
  3.    +-------------------------------------------------|              |
  4.    | Program     : HTML-Heaven   Version     : 1.3   |              |
  5.    +----------------------------------------------------------------+
  6.    |                                                                |
  7.    | NAME        :                                                  |
  8.    |                                                                |
  9.    | ADDRESS     :                                                  |
  10.    |                                                                |
  11.    | CITY        :                                                  |
  12.    |                                                                |
  13.    | COUNTY      :                                                  |
  14.    |                                                                |
  15.    | COUNTRY     :                                                  |
  16.    |                                                                |
  17.    | SEX         : _M/_F*    DATE OF BIRTH :                        |
  18.    |                                         (DD-MMM-YY)            |
  19.    | PHONE-NUMBER:                             (Voice/Data)*        |
  20.    | FAX-NUMBER  :                                                  |
  21.    |                                                                |
  22.    | E-MAIL ADDR.:                                                  |
  23.    | (NETWORK)   :                                                  |
  24.    |                                                                |
  25.    | AMIGA CONFIG: _ A500   _ A2000   Kick*    CPU*     Memory      |
  26.    |               _ A500+  _ A3000   _ 2.0x   _ 68000  __ MB       |
  27.    |               _ A600   _ A3000T  _ 2.1    _ 68020              |
  28.    |               _ A1000  _ A4000   _ 3.0    _ 68030  Harddisk    |
  29.    |               _ A1200  _ A4000T  _ 3.1    _ 68040  __ MB       |
  30.    |               _ CD32   _ Other   _ Other  _ 68060              |
  31.    |                                                                |
  32.    |               (Text)Editor used:                               |
  33.    |                                                                |
  34.    |               WWW browser  used:                               |
  35.    |                                                                |
  36.    | COMMENTS    :                                                  |
  37.    |                                                                |
  38.    |                                                                |
  39.    |                                                                |
  40.    |                                                                |
  41.    |                                                                |
  42.    |                                                                |
  43.    | By sending in this registration, I agree to abide by the terms |
  44.    | as specified in the HTML_Heaven.guide document.                |
  45.    |                                                                |
  46.    | Signature:                       Date  :                       |
  47.    |                                  Place :                       |
  48.    |                                                                |
  49.    |                                  * Tick the appropriate please |
  50.    |                                                                |
  51.    | ...............................                                |
  52.    +----------------------------------------------------------------+
  53.    | Send to  :  P. Kolenbrander                                    |
  54.    |             Turfveldenstraat 37                                |
  55.    |             NL-5632 XH  EINDHOVEN                              |
  56.    |             The NETHERLANDS                                    |
  57.    |                                                                |
  58.    | INTERNET : paul@serena.iaehv.nl                                |
  59.    +----------------------------------------------------------------+
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