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               ProBoard version 2.12     ----     Registration Form
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         Your Name    :  ______________________________________ (required!)

         Company      :  __________________________________________________

         Sysop Name   :  ______________________________________ (required!)

         BBS name     :  ______________________________________ (required!)

         Address      :  __________________________________________________

                         __________________________________________________

                         __________________________________________________

         Voice Phone# :  __________________________________________________

         BBS Phone#   :  __________________________________________________

         Your FidoNet addresss (if applicable):  __________________________

         Type of registration: ( ) Personal         ( ) With printed manual
                               ( ) Commercial       ( ) On disk

         Payment method      : ( ) Check/Cash       ( ) VISA
                               ( ) Bank Transfer    ( ) Mastercard/Eurocard

         Amount       : ______________ (in registration site's currency!!)


         Credit Card #: _______________________________   Expires: ___/___

         Name on card : _______________________________

         Signature    : _______________________________


         Your key file will be sent to you via FidoNet netmail or you can
         download it from the registration site's BBS.  We can also send it
         to you on a diskette, but this will delay your registration
         considerably (and it will cost you extra).

         Please select how you would like to receive your key below:

         ( ) Netmail                     ( ) 3"1/2 Diskette (extra cost)
         ( ) Download from our BBS       ( ) 5"1/4 Diskette (extra cost)