Internet Message Center Registration Form



Name             :___________________________________________________


Address          :___________________________________________________


City/State       :___________________________________________________


ZIP              :___________________________________________________


Country          :___________________________________________________


BBS Name         :___________________________________________________


BBS Number       :___________________________________________________


FidoNet Node #   :___________________________________________________


Register to      :___________________________________________________
                 [Sysop or BBS Name]




Registration cost: $13.00 US.

Send payment--check, cash or money order TO: Ray Khechen
                                             5424 Sunol Blvd #162
                                             Pleasanton, Ca 94566




                          Thank you for your support!