____        _      __      _____ _ __
              / __ \__  __(_)____/ /__   / ___/(_) /   _____  _____
             / / / / / / / / ___/ //_/   \__ \/ / / | / / _ \/ ___/
            / /_/ / /_/ / / /__/ ,<     ___/ / / /| |/ /  __/ /
            \___\_\__,_/_/\___/_/|_|   /____/_/_/ |___/\___/_/
               ___           _     __           __  _
              / _ \___ ___ _(_)__ / /________ _/ /_(_)__  ___
             / , _/ -_) _ `/ (_-</ __/ __/ _ `/ __/ / _ \/ _ \
            /_/|_|\__/\_, /_/___/\__/_/  \_,_/\__/_/\___/_//_/
                     /___/


   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:____________________