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Text File  |  1991-09-05  |  4.3 KB  |  59 lines
  1. +-------------------------------------------------------------------------+
  2. | T E C H N O       T R I V I A      R E G I S T R A T I O N      F O R M |
  3. +-------------------------------------------------------------------------+
  4. |                                                                         |
  5. | Your Name _____________________________________________________________ |
  6. |                                                                         |
  7. | BBS Name ______________________________________________________________ |
  8. |                                                                         |
  9. | Street Adress _________________________________________________________ |
  10. |                                                                         |
  11. | City, State and Zip Code ______________________________________________ |
  12. |                                                                         |
  13. | Country _______________________________________________________________ |
  14. |                                                                         |
  15. | Voice Phone (____) _____-______            BBS Phone (____) _____-_____ |
  16. |                                                                         |
  17. | Suggestions/Comments/Bugs _____________________________________________ |
  18. |                                                                         |
  19. | _______________________________________________________________________ |
  20. |                                                                         |
  21. | _______________________________________________________________________ |
  22. |                                                                         |
  23. |                Please Select The Options You Would Like:                |
  24. |                                                                         |
  25. |    # Of Nodes ____  Basic Registration Fee..$15.00/Node                 |
  26. |                                                                         |
  27. |                                                                         |
  28. |                                                                         |
  29. |                [ ]  3 1/2" Low Density Disk..$2.00                      |
  30. |                [ ]  5 1/4" High Density Disk.$1.00                      |
  31. |                                                                         |
  32. |                     Question Packs                                      |
  33. |                     ------------------------------                      |
  34. |                [ ]  General I                $6.00                      |
  35. |                [ ]  General II               $6.00                      |
  36. |                [ ]  General III              $6.00                      |
  37. |                [ ]  General IV               $6.00                      |
  38. |                [ ]  Music I                  $6.00                      |
  39. |                [ ]  Music II                 $6.00                      |
  40. |                [ ]  Brain-Strain I           $6.00                      |
  41. |                [ ]  Brain-Strain II          $6.00                      |
  42. |                [ ]  The 80's                 $6.00                      |
  43. |                     --------------------+------------+                  |
  44. |                     Grand Total         | $          |                  |
  45. |                                         +------------+                  |
  46. |                                                                         |
  47. +-------------------------------------------------------------------------+
  48.  
  49. +-------------------------------------------------------------------------+
  50. |                                                                         |
  51. |             Make Checks Payable To David Mitchell and mail to:          |
  52. |                                                                         |
  53. |                          Player's Choice Software                       |
  54. |                          c/o David Mitchell                             |
  55. |                          36205 6 Mile Road                              |
  56. |                          Livonia, MI 48152                              |
  57. |                                                                         |
  58. +-------------------------------------------------------------------------+
  59.