     FT1000MP RELEASE 1.0 Individual User Registration Form
   =========================================================

     1. User information (please PRINT):
    ------------------------------------- 
     Name : ___________________________________________________________

     Street : __________________________________Nr :_____Bus :_________

     City : ___________________ State: _____________ ZIP: _____________

     Country : ____________________________________

     Phone number : (___)______________ Date (MM/DD/YY): ____/____/____

     Email address: ___________________________________________________

     Call : ___________________________________________________________

     2. Payment and fees:
    ----------------------

     Fees are in US dollars, IF you send cash it's at your own risk.
     Sometimes mail gets lost or stolen, I haven't had that problem
     yet personnally, but you never know.
     Checks must be made payable to DEWAELHENS GUY .
     Select form of payment (check one):
 
     __ Enclosed check order
     __ Enclosed Money order

     3. Costs:
    -----------

     ( ) email delivery...................................... $10.00
     ( ) disk  delivery...................................... $15.00

     4. Mail this form with your chosen form of payment to: 
    --------------------------------------------------------

     DEWAELHENS GUY
     DIJKSTRAAT 83
     B-9200 DENDERMONDE
     BELGIUM
