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1993-05-12
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2KB
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65 lines
Registration form for
Radical Computer Systems
-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
Full Name : ____________________________________
Address Line 1 : ___________________________________
Address Line 2 : ___________________________________
City : ___________________ State : ____________ ZipCode : ____________
Telephone Number (optional) : ___________________________
BBS Name : _____________________________________________
BBS Number : _____________________
Name to register program(s) to : _____________________________________
Program(s) being registered:
### Name Reg Fee
─── ─────────────────────────────────── ───────
01: ___________________________________ $______
02: ___________________________________ $______
03: ___________________________________ $______
04: ___________________________________ $______
05: ___________________________________ $______
Total : $______
How do you wish to receive your registration code:
[ ] US Mail.
[ ] The Ace of Spades BBS
Real Name: __________________________ Handle: _________________________
[ ] FidoNet NetMail message
Name: ____________________________________ Node Number: ________
Make all checks and money orders out to: David Proper
Send this form along with check or money order to:
David Proper
927 Maple Avenue, North west.
New Philadelphia, Ohio 44663-1522
You should receive your registration code within one (1) week.