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     [                         Registration Form                            ]
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     [   Date: __________                    TO:  Ralph LoBianco            ]
     [                                            Suite #231                ]
     [                                            7143 State Road 54        ]
     [                                            New Port Richey, FL 34653 ]
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     [   FROM:     Name: ________________________________________           ]
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     [          Address: ________________________________________           ]
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     [                   ________________________________________           ]
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     [                   ________________________________________           ]
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     [     BBS Name ______________________________________________          ]
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     [     Modem Type/Max Baud Rate ______________________________          ]
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     [     BBS Phone # (_____)_________________________                     ]
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     [     Voice Phone # (_____)_______________________                     ]
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     [   PROGRAM NAME:______________  VERSION:___________________           ]
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     [   WHERE DID YOU GET IT: __________________________________           ]
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     [   IF BBS, NAME & PHONE: __________________________________           ]
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     [   COMMENTS:_______________________________________________           ]
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     [   ________________________________________________________           ]
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     [   ________________________________________________________           ]
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     [   ________________________________________________________           ]
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     [   ________________________________________________________           ]
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     [             SETED  Registration Fee....... _ $5.00___                ]
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     [             FL residents add sales tax .... __________               ]
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     [             Total Enclosed ................ __________               ]
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     [         Please DO NOT send cash.  Send check or money order.         ]
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