
Register MAKHLP 
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NAME:_________________________________________________________________

Company:___________________________________________________________________

Address:___________________________________________________________________

City/state:________________________________________________________________

Zipcode:___________________________________________________________________

Country:-------------------------------------------------------------------

E-Mail:____________________________________________________________________

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Pricing:
        Normal registration:
                200F for FRANCE                           (  )
                250F for other countries 45$

        
        Disk Format:    ( )3.5"   ( )5.25"


Propositions:___________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________




Signature:



payment:
       Money payment
       postal money-order

ADDRESS:

        Mr VERBAERE
        10 RUE DE LA BRANCHOIRE
        44800    SAINT HERBLAIN
                         FRANCE

