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ANSi Art File  |  1996-09-15  |  2.9 KB  |  640x368  |  4-bit (6 colors)
   ocr: DarkStar 1.02a ANSI Mode NewUser Questionnaire NewUser Questionnaire Last Name - - First Name : - Middle Initial : Alias - - Password Address City State - - Country: ZIP - : Date of Birth : Voice Number : Data Number