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  1.  
  2.     05R/W Registration Form
  3.     =======================
  4.  
  5.     To:
  6.  
  7.     Maxime Doyen
  8.     A2/12 rés. Planche Epinoy
  9.     Avenue de Flandres
  10.     59170 Croix
  11.     France
  12.  
  13.     Registration Informations:
  14.     --------------------------
  15.  
  16.      Name: FirstName FamilyName                
  17.            ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
  18.    Street: Nr., Street, District               
  19.            ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
  20.  ZIP,City: PostalCode, City, County            
  21.            ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
  22.   Country: England            
  23.            ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
  24.     Phone: +44-000-000-0000   
  25.            ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
  26.     EMail: user@host.domain                      
  27.            ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
  28.  
  29.     05R/W Registration Amount (Only Cash: FF, DM, £, US$):
  30.     ------------------------------------------------------
  31.     +-+
  32.     | |   80 FF Cash (or eq. DM, £, US$) - Receive via E-Mail
  33.     +-+
  34.     | |  100 FF Cash (or eq. DM, £, US$) - Receive on 3,5" DD via Snail Mail
  35.     +-+
  36.  
  37.   Optional comments:
  38.  
  39.                                                                     
  40.   ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
  41.                                                                     
  42.   ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
  43.  
  44.  
  45.     I have read the copyright details and agree.
  46.  
  47.  
  48.  
  49.    ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯         ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
  50.             (City, Date)                           (Signature)
  51.