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  1. #####################################################
  2. #             Backer Registration Card              #
  3. #####################################################
  4.  
  5. Name_______________________________________________________________
  6.  
  7. Address_____________________________________________________________
  8.  
  9. City__________________________ State ____________________ZIP________
  10.  
  11. Country________________________E-mail ______________________________
  12.  
  13. ‚Ä¢___ I want to receive my registration number by E-Mail.
  14.  
  15. I register my Backer copy, version ___.___ 
  16.  
  17. My payment :         
  18.      Mode
  19.                  ____ cash
  20.                  ____ check
  21.  
  22.     Currency
  23.                        ____  US $ 20
  24.                  ____  100 French Francs
  25.                  ____  13 British Pounds
  26.                  ____  30 German D-Mark
  27.                  ____  Canadian $ 28
  28.                  ____  2100 Yen
  29.  
  30. Date : ___________________________ Signature_________________________ 
  31.  
  32.  
  33. ‚Ä¢The way I've got Backer :
  34. ___________________________________________________________________________
  35.  
  36. ___________________________________________________________________________
  37.  
  38. ‚Ä¢My remarks:
  39. ___________________________________________________________________________
  40.  
  41. ___________________________________________________________________________
  42.  
  43. ***************************************************************************
  44. Mail to        :       
  45.                   M Didier & Olivier GUILLION
  46.                36 rue de la Jeunesse
  47.                31200 Toulouse 
  48.                                                             FRANCE
  49.  
  50.