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Text File  |  1994-05-11  |  752b  |  14 lines
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  2.        ┌─────────────────────────────────────────────────────────┐
  3.        │ [ ] YES, i want to have a free TEST-CRC for THE JL's    │
  4.        │          Options (up to four): ________________________ │
  5.        │                                                         │
  6.        │ Name:      ____________________        Date: MM-DD-YYYY │
  7.        │ Address:   ____________________   BirthDate: MM-DD-YYYY │
  8.        │ Address:   ____________________    Net/Node: ____ /____ │
  9.        │ ZIP City:  ____________________________________________ │
  10.        │ Country:   _______________________  GT Version: _______ │
  11.        │ Voice:     ____________________ BBS: __________________ │
  12.        └─────────────────────────────────────────────────────────┘
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