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  1.  
  2. ZipIt Registration Form
  3.  
  4. Name:         _______________________________________________
  5. Organization: _______________________________________________
  6. Address:      _______________________________________________
  7.               _______________________________________________
  8. Country:      _____________
  9.  
  10. Phone: __________________
  11. Fax:   __________________
  12.  
  13. ZipIt version: 1.3
  14.  
  15. Where did you obtain ZipIt? ______________________________
  16.  
  17. Please indicate up to five electronic addresses. Place an asterisk next to the one you prefer:
  18.  
  19. ______________________________
  20. ______________________________
  21. ______________________________
  22. ______________________________
  23. ______________________________
  24.  
  25. If registering with NetCash, please enter your $15 NetCash certificate(s) here:
  26.  
  27. ____________________________
  28. ____________________________
  29. ____________________________
  30.  
  31.  
  32. If using NetCash, please email this form to tbrown@dorsai.org. Otherwise, please mail to:
  33.  
  34. (school year)
  35. Tommy Brown
  36. P.O. Box 203425
  37. New Haven, CT  06520-3425
  38.  
  39. (summer)
  40. Tommy Brown
  41. 110-45 Queens Blvd. Apt. 716
  42. Forest Hills, NY  11375
  43.  
  44. Please see the documentation regarding corporate registrations and site licenses.
  45.  
  46. Thanks for registering!