               APPLICATION FORM FOR GBLIB2.EXE REGISTRATION KEY
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All information is deemed private and confidential
If a field does not apply, then type 'Not Applicable'

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First Name _________________________________________________________________

Last Name __________________________________________________________________

Date of Birth ______________________________________________________________

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EMail Address 1 ____________________________________________________________

EMail Address 2 ____________________________________________________________

EMail Address 3 ____________________________________________________________

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Home Adddress Line 1 _______________________________________________________

Home Adddress Line 2 _______________________________________________________

Home Adddress City/Town ____________________________________________________

Home Adddress State/County _________________________________________________

Home Adddress Country ______________________________________________________

Home Telephone Number (Inc Country code)____________________________________

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Profession/Job Title _______________________________________________________

Employer/Business Address 1 ________________________________________________

Employer/Business Address 2 ________________________________________________

Employer/Business Address 3 ________________________________________________

Employer/Business Address 4 ________________________________________________

Employer/Business Address 5 ________________________________________________

Employer Telephone Number (Inc Country code) _______________________________

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Date of request (Todays Date) ______________________________________________

CIS Account Number _________________________________________________________

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AGREEMENT
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I agree that I will not use GBLIB.EXE for anything other than legal and
proper use, and that I will not reveal my GBLIB2 code password to anyone.

I understand that the infomation contained in this form will only remain
confidential if I keep the above agreement.

I declare that the source code supplied with this form is my own work.

Use MakeAKey to encrypt your CIS Password, and type the resulting number
here ______________ as your signature to this agreement, and the declaration.

NOTE: Failure to sign this form will make it null and void.

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