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                      Mercury v2.xx Registration Form
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   Name:______________________________________________________________

Address:______________________________________________________________

   City:_________________________  St/Prov:___________________________

Country:_________________________  Post Code:_________________________


Internet EMail:_______________________________________________________

Net Address:______________________ Network:___________________________

Voice Phone:______________________ BBS Phone:_________________________


Select method of delivery.

[  ]  Email my keyfile to my address above.

[  ]  Place my keyfile on hold for me to pick up at 1:382/311.0

[  ]  Mail my keyfile on disk to my address above.



Select method of payment.


      Mercury Only

[  ]  I have enclosed $5.00 US in cash.

[  ]  I have enclosed a personal check for $5.00 US.

[  ]  I have enclosed a money order for $5.00 US.


      Mercury / Quick Silver Combination

[  ]  I have enclosed $15.00 US in cash.

[  ]  I have enclosed a personal check for $15.00 US.

[  ]  I have enclosed a money order for $15.00 US.



Signature:_________________________________  Date:____________________


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