SplitMail Version 1.0 Registration form.


Registration Name: ________________________
note: this is the name you want to register under.


First Name __________________________


Last Name___________________________


Your email address: ________________________


Your regular mailing address:

          _________________________

          _________________________

              City: ______________________

                     State/Province___________________

                     Country_______________________

          Postal code: _____________



Please include a check or money order for $15 US funds ($20 Cdn) made payable to John
Zeweniuk.

Send to          SplitMail
               Box 1359
               Parksville, B.C.
               Canada
               V9P 2H3
     
Thank you for registering! You will receive a registration code by email.