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Text File  |  1992-10-06  |  3KB  |  53 lines
  1.  
  2.             _______________________________________________________
  3.            |                                                       |
  4.            |                                                       |
  5.            |           BEST BIORHYTHM REGISTRATION FORM            |
  6.            |                (Please print or type)                 |
  7.            |                                                       |
  8.            |                                                       |
  9.            |  NAME OF                                              |
  10.            |  REGISTRANT________________________________________   |
  11.            |                                                       |
  12.            |  ADDRESS __________________________________________   |
  13.            |                                                       |
  14.            |  CITY___________________ STATE & ZIP_______________   |
  15.            |                                                       |
  16.            |  COUNTRY_______________                               |
  17.            |                                                       |
  18.            |      Registered owners may sell or give away the      |
  19.            |      printouts generated by the Best Biorhythm        |
  20.            |      program.                                         |
  21.            |                                                       |
  22.            |      Registration fee of $10.00 enclosed.             |
  23.            |                                                       |
  24.            |           CHECK____   MO____   CASH____               |
  25.            |                                                       |
  26.            |      Make check or money order payable to:            |
  27.            |                                                       |
  28.            |                 L. W. Brenneman                       |
  29.            |                                                       |
  30.            |      Mail to:   Forecasts                             |
  31.            |                 P.O. Box 10665                        |
  32.            |                 Erie, PA 16514                        |
  33.            |_______________________________________________________|
  34.            |                                                       |
  35.            |  This part is optional:                               |
  36.            |                                                       |
  37.            |  How did you receive Best Biorhythm? (Check one)      |
  38.            |                                                       |
  39.            |     From a BBS_______     A friend _______            |
  40.            |                                                       |
  41.            |     A mailorder shareware dealer   _______            |
  42.            |                                                       |
  43.            |     A local computer store         _______            |
  44.            |                                                       |
  45.            |     Name of BBS, dealer or store (still optional)     |
  46.            |                                                       |
  47.            |     _______________________________________           |
  48.            |                                                       |
  49.            |     Thank you                                         |
  50.            |_______________________________________________________|
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