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                      Quick Silver Registration Form
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   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 $15.00 US in cash.

[  ]  I have enclosed a personal check for $15.00 US.

[  ]  I have enclosed a money order for $15.00 US.

[  ]  I have enclosed payment in my local currency 

      in the amount of _____________




Signature:_________________________________  Date:____________________