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Text File  |  1994-06-25  |  2KB  |  50 lines
  1.  
  2.         * * * *   LOPAKA'S BLACKJACK DOOR REGISTRATION FORM  * * * *
  3.  
  4.      Mail to:  Robert Fortune
  5.                48 West 17th Street #B303
  6.                New York, N.Y. 10011
  7.                USA
  8.  
  9.      Registration Fee: $10.00 (U.S. Funds)
  10.  
  11.                                                           DATE:   /  /
  12.  
  13.      BBS Name: ___________________________________________________________
  14.  
  15.      First Name: ______________________     Last Name: ___________________
  16.  
  17.      BBS Phone Number: ___________________________________________________
  18.  
  19.      (Node 2)          ____________________________________________________
  20.  
  21.      (Node 3)          ____________________________________________________
  22.  
  23.      BBS Software: ________________________________________________________
  24.  
  25.      Street Address: ______________________________________________________
  26.  
  27.      City: _____________________  State: __________________ Zip: __________
  28.  
  29.      Country: __________________
  30.  
  31.      Voice Number: (   ) _____________ [Optional]
  32.  
  33.      Version of Lopaka's BlackJack door that I have is : _.__
  34.  
  35.      Comments: ____________________________________________________________
  36.  
  37.      ______________________________________________________________________
  38.  
  39.      ______________________________________________________________________
  40.  
  41.      ______________________________________________________________________
  42.  
  43.      ______________________________________________________________________
  44.  
  45.      ______________________________________________________________________
  46.  
  47.    * (Please make your checks payable to Robert Fortune)
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