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/ Amiga Plus 2004 #2 / Amiga Plus CD - 2004 - No. 02.iso / AmigaPlus / Games / PairsNG / RegistrationForm < prev    next >
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  1.       
  2.           ********************************
  3.           **    PairsNG Registration    **
  4.           **    5 Years Amiga Arena     **
  5.           **      Birthday Price        **
  6.           ********************************
  7.  
  8.  
  9. First:         ____________________________
  10.  
  11. Name:          ____________________________
  12.  
  13.  
  14. Street:        ___________________________  ___
  15.  
  16.  
  17. Postal code:   ____________
  18.  
  19. City:          ____________________________
  20.  
  21.  
  22. Country:       ________________________
  23.  
  24.  
  25.  
  26. Keyfile Receipment via:
  27.  
  28.    O E-Mail          O Mail 
  29.    
  30.                         -> O 3,5" Floppy disk        
  31.                      
  32.                         -> O CD-R 
  33.                              
  34.    
  35. E-Mail Adress: _____________________________
  36.  
  37.  
  38. Comments:      __________________________________
  39.  
  40.                __________________________________
  41.  
  42.                __________________________________    
  43.           
  44.  
  45. I will send the money:   O cash
  46.                          O money transfer
  47.                          O PayPal *
  48.  
  49.  
  50. Price: 5 Euro (+ extra costs if receipment via disk or CD-R
  51.        is choosen; read manual for details)
  52.  
  53.        
  54.  
  55.  
  56. City/Date/Sign:  _____________ xx.xx.xx _________________       
  57.  
  58.  
  59. You can send this form via Email to pairs@def-con.net
  60.  
  61. Adress:                       
  62. Christoph Kimna                 
  63. Fuchshoehlenweg 17            
  64. 58706 Menden                    
  65. Germany                       
  66.  
  67. * + 0.45 EUR for Paypal fees