Derby Day Registration:  $20.00 U.S.



Please print

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Name:


Address:


City:                                 St:           Zip:


Voice phone number :


BBS Information
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BBS name and number:
 
BBS software & version:

Name as you wish to appear on the opening screen:


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Send to :

           Rich Smith
           760 Carmelita Dr.
           Salinas, Ca. 93901


Please attach any comments you might have about Derby Day!