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  1.                          The Informed Christian Network                    
  2.                              USER REGISTRATION FORM                        
  3.       1303 W. Buckingham Rd., #103/162              Telephone: M-F 10am-4pm
  4.       Garland, TX. 75040                                       214-271-2487
  5.       ---------------------------------------------------------------------
  6.                                                                           
  7.       Date: ...........  Password desired (8 chars exactly) :.:.:.:.:.:.:.:.:
  8.                                                                           
  9.       Name: ..........................................................
  10.                     Last                   First               M.I.
  11.                      (You must use your real name to register.)
  12.                                                                           
  13.       Address: .......................................................
  14.                                                                           
  15.       City: ...........................  State: ......  Zip: .........
  16.                                                                           
  17.       Employer or
  18.       Company Name: ..................................................
  19.                                                                           
  20.       Bus. Phone: .(....)............. Hm. Phone: .(....).............
  21.                                                                           
  22.       Type of Computer: ..............................................
  23.                                                                           
  24.       Please register me on ICN as a:
  25.         * Non-subscribing user (BBS services only)........: [ ]
  26.  
  27.         * Subscriber at $40 for 12 months:      [ ]
  28.                         $55 with Bible/QSEARCH  [ ]
  29.  
  30.         * Subscriber at $20 for 6 months :      [ ]
  31.                         $35 with NT/QSEARCH     [ ]
  32.                                                                           
  33.         * Supporter or       a) Monthly gift of  $..........
  34.           Core member
  35.                              b) One-time gift of $..........
  36.  
  37.         * Information, equipment, or services supporter...: [ ]
  38.             (Please contact ICN to give details of your offer.)           
  39.  
  40.         * Non-profit ministry.............................: [ ]
  41.                                                                           
  42.       Ministry or
  43.       Organization Name: ...........................................
  44.                                                                           
  45.       .........................  Ministry Phone: .(....)............
  46.                                                                           
  47.       Address: .....................................................
  48.                                                                           
  49.       City: .........................  State: ......  Zip: .........
  50.                                                                           
  51.       OTHER: Send SIG Application [ ]  Contact me at (...)...-....
  52.  
  53.       SIGNATURE (Required for registration) ...........................
  54.       .................................................................
  55.         Please enclose subscription fee or support gift with this form.
  56.         Current data line: 214-271-2487 M-F 4pm-10am, 24 hr. S-Su.
  57.         Terminal settings: 300/1200/8/N/1
  58.                The Informed Christian Network is a ministry of
  59.                CHRISTIAN INFORMATION MINISTRIES, INTERNATIONAL.
  60.                    (All contributions are tax deductable.)
  61.  
  62.