REGISTRATION FORM  Another Brick In The Wall v1.3 


Name             :___________________________________________________


Address          :___________________________________________________


City/State       :___________________________________________________


ZIP              :___________________________________________________


Country          :___________________________________________________


BBS Name         :___________________________________________________


BBS Number       :___________________________________________________


FidoNet Node #   :___________________________________________________


Register Wall to :___________________________________________________
                 [Sysop or BBS Name]


Optional: From where did you originally download The Wall? 

          ________________________________________________

Choose one:

[  ] My BBS is a member of FidoNet; please send me my registration key
     at the node number listed above.

[  ] I will call Temples of Syrinx, 908/914-9807, and download my registration
     key.  Indicate a password below if you do not already have an account on
     Syrinx and wish to have one premade based on the above information.

     PASSWORD: _________________ 


Registration cost: $5.00US.

Send payment--check, cash or money order TO: Scott Stuart
                                             832 Ship Avenue
                                             Beachwood, NJ  08722




                          Thank you for your support!
