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Text File  |  1995-09-05  |  4KB  |  58 lines
  1.       +----------------------------------------------------------------+
  2.       |                      REGISTRATION FORM          |              |
  3.       +-------------------------------------------------|              |
  4.       | Program     : HTML-Heaven   Version     : 1.2   |              |
  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.       | COMMENTS    :                                                  |
  35.       |                                                                |
  36.       |                                                                |
  37.       |                                                                |
  38.       |                                                                |
  39.       |                                                                |
  40.       |                                                                |
  41.       | By sending in this registration, I agree to abide by the terms |
  42.       | as specified in the HTML_Heaven.guide document.                |
  43.       |                                                                |
  44.       | Signature:                       Date  :                       |
  45.       |                                  Place :                       |
  46.       |                                                                |
  47.       |                                  * Tick the appropriate please |
  48.       |                                                                |
  49.       | ...............................                                |
  50.       +----------------------------------------------------------------+
  51.       | Send to  :  P. Kolenbrander                                    |
  52.       |             Turfveldenstraat 37                                |
  53.       |             NL-5632 XH  EINDHOVEN                              |
  54.       |             The NETHERLANDS                                    |
  55.       |                                                                |
  56.       | INTERNET : paul@serena.iaehv.nl                                |
  57.       +----------------------------------------------------------------+
  58.