

        Registration form for REMIND1B.PPE v1.0b

        
        Name:   _________________________________________
        
        Street: _________________________________________

        City:   _________________________________________

        State:  __________________ Postal Code __________
         
        Country:_________________________

        Phone Number: ___________________________________

        BBS Name:     ___________________________________

        BBS Number:   ___________________________________

        Comments:     ___________________________________

                      ___________________________________  
                      
                      ___________________________________

        
        Would you like to receive Software Kitchen Newsletter?
                [  ] Yes   [  ] No


        Signature _____________________ Date ____________    

