                   B O M B T R A C K  Registration Form
                   ------------------------------------

                    © Copyright 1993 by Michel Clement

                    * ShareWare, freely distributable *

    Yeah, please express me my keyfile so I can taste Bombtrack fully.
 I really love BombTrack and am desperately waiting to become a registered
                             System Operator!


     Name:      ____________________________________________________________

     Address:   ____________________________________________________________

                ____________________________________________________________

                ____________________________________________________________

     Country:   __________________

     Phone:     +___+(____)+__________ (voice)

     E-Mail:    ____________________________________________________________
     
                ____________________________________________________________

                ____________________________________________________________

     BBS:       ____________________________________________________________


     Dialog serial number: PR/RE____

     Kickstart version:  _____  Workbench Version:  _____  CPU: 680__

     Comments:  ____________________________________________________________

                ____________________________________________________________

                ____________________________________________________________

                ____________________________________________________________

                ____________________________________________________________


Please tick the way you want to receive your keyfile:

[ ] Netmail the keyfile uuencoded to the following FidoNet
    address: ___:____/____.___

[ ] Netmail the keyfile uuencoded to the following InterNet
    address: __________________________

[ ] Please put the keyfile on hold on your system. I will pick it up!
    (optional) Please set up the following session password: ____________

[ ] Please send me my keyfile to my snail address at the top!


I'm sending you [ ] 15.- US-$ or [ ] 20.- Swiss Francs in:

[ ] A EuroCheque (payable to 'Michel Clement' only!)
[ ] A postal money order
[ ] A wire bank transfer
[ ] Cash (at your own risk!)



					Yours sincerely,



					__________________________

					(please sign here)



Snail mail:              Bank account:

Michel Clement           Swiss Bank Corporation, Basel, Switzerland
Baumgartenweg 10         Account Nr. 29-903,118, payable to my
CH-4153 Reinach          name & address on the left.
Switzerland

E-Mail:

Michel Clement, FidoNet: 2:301/215.0 & 2:301/235.0
                AmiNet:  44:8010/201.0 & 44:8010/202.0
                UseNet:  mike@miracle.aare.net.ch
                BBS:     +41-61-7117421 (HST)
                         +41-61-7121306 (ZyXEL)
                FAX:     +41-61-7121306
