__  ___
                    /  |/  /__  ____________  _________  __
                   / /|_/ / _ \/ ___/ ___/ / / / ___/ / / /
                  / /  / /  __/ /  / /__/ /_/ / /  / /_/ /
                 /_/  /_/\___/_/   \___/\__,_/_/   \__, /
                                                  /____/
   ___           _     __           __  _             ____
  / _ \___ ___ _(_)__ / /________ _/ /_(_)__  ___    / __/__  ______ _
 / , _/ -_) _ `/ (_-</ __/ __/ _ `/ __/ / _ \/ _ \  / _// _ \/ __/  ' \
/_/|_|\__/\_, /_/___/\__/_/  \_,_/\__/_/\___/_//_/ /_/  \___/_/ /_/_/_/
         /___/


   Name:______________________________________________________________

Address:______________________________________________________________

   City:_________________________  St/Prov:___________________________

Country:_________________________  Post Code:_________________________



Net Address:______________________ Network:___________________________

Voice Phone:______________________ BBS Phone:_________________________


Select method of delivery.

[  ]  Crashmail my keyfile to me to my address above.

[  ]  Place my keyfile on hold for me to pick up.

[  ]  Mail my keyfile on disk to my address above.

[  ]  Have dinner ready, I'll be stoping by shortly! :-)


Select method of payment.

[  ]  I have enclosed $5.00 US in cash.

[  ]  I have enclosed a personal check for $5.00 US.

[  ]  I have enclosed a money order for $5.00 US.

[  ]  I have enclosed payment in my local currency

      in the amount of _____________


Signature:_________________________________  Date:____________________


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