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  1.                                       User Registration Form
  2.  
  3. Please complete the form below, then email your registration details to our 
  4. address:    support@gaiaweb.com
  5. When completing the form, you should delete all non-relevant categories. In 
  6. addition, please attach the subject: "touroku" to the email you send. Thank you 
  7. for registering with GAIA Associates Inc.
  8.  
  9. 1.    Name
  10.  
  11. 2.    Product - CAPCOM TM Original Screen Saver
  12.  
  13. 3.    Address
  14.  
  15. 4.    Telephone
  16.  
  17. 5.    Job
  18.  
  19. 6.    Date of Birth    (Year/Month/Day)
  20.  
  21. 7.    Age
  22.  
  23. 8.    Sex    (Male/Female)
  24.  
  25. 9.    Date of Purchase
  26.