IPNET.PPE REGISTRATION APPLICATION ______________________________________________________ MAIL to: Michele Stewart (305) 432-2223 (14.4 HST/DS) 2041 Bayberry Drive (305) 433-3495 (14.4 HST/DS) Pembroke Pines, FL 33024 Date: ***> FIRST and LAST NAME _______________________________________________ ADDRESS _______________________________________________ CITY, STATE, ZIP _________________________ ____ ___________ VOICE/BBS PHONE # _________________________/_____________________ ***> YOUR BBS NAME _______________________________________________ Password for pre-registration on SunShine _________________________ ------------------------------------------------------------------------------ Program Name:______________________ Version:______________________ TOTAL Enclosed__________(U.S. FUNDS ONLY !!!!) DO NOT SEND CASH!! Make Check/Money Order Payable to: MICHELE STEWART ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ CREDIT CARDS accepted ONLINE ^^^^^^^^^^^^^^^^^^^^^^^^^^^^ => Registration numbers will be made available, in a message, on SunShine OR => enclose a self-addressed stamped envelope to receive them by return mail! ***> NOTE: THESE ITEMS MUST MATCH EXACTLY WITH THE WAY YOU HAVE ENTERED THEM IN THE CONFIGURATION FILE. UPPER AND LOWER CASE IS CRITICAL !!!!! (05/16/93) --------------------------- For Internal Use Only ---------------------------- Date Received __________________ Amt Received ____________