APPLICATION FORM FOR GBLIB2.EXE REGISTRATION KEY ================================================ All information is deemed private and confidential If a field does not apply, then type 'Not Applicable' ============================================================================ First Name _________________________________________________________________ Last Name __________________________________________________________________ Date of Birth ______________________________________________________________ ============================================================================ EMail Address 1 ____________________________________________________________ EMail Address 2 ____________________________________________________________ EMail Address 3 ____________________________________________________________ ============================================================================ Home Adddress Line 1 _______________________________________________________ Home Adddress Line 2 _______________________________________________________ Home Adddress City/Town ____________________________________________________ Home Adddress State/County _________________________________________________ Home Adddress Country ______________________________________________________ Home Telephone Number (Inc Country code)____________________________________ ============================================================================ Profession/Job Title _______________________________________________________ Employer/Business Address 1 ________________________________________________ Employer/Business Address 2 ________________________________________________ Employer/Business Address 3 ________________________________________________ Employer/Business Address 4 ________________________________________________ Employer/Business Address 5 ________________________________________________ Employer Telephone Number (Inc Country code) _______________________________ ============================================================================ Date of request (Todays Date) ______________________________________________ CIS Account Number _________________________________________________________ ============================================================================ AGREEMENT ========= I agree that I will not use GBLIB.EXE for anything other than legal and proper use, and that I will not reveal my GBLIB2 code password to anyone. I understand that the infomation contained in this form will only remain confidential if I keep the above agreement. I declare that the source code supplied with this form is my own work. Use MakeAKey to encrypt your CIS Password, and type the resulting number here ______________ as your signature to this agreement, and the declaration. NOTE: Failure to sign this form will make it null and void. ============================================================================