
            SF-FAM Registration Form

    Registration code:
        SF-FAM $15.00 ___   (U.S. and International Locations)

    International customers:
	Please pay by checks drawn on a U.S. bank, or with a credit card.
    
Name___________________________________________________________________
Address________________________________________________________________
City__________________ State__ Zip__________
Phone________________
Your name EXACTLY as it appears in SF-FAM__________________________

YOUR BBS NAME AND NUMBER(optional)_____________________________________

SF-FAM version currently using_____________________________________

      Please mail this form to:
        Fifth Dimension
        P.O. Box 18956
        Tucson, Az 85731

NOTE:If you want your registration sent via e-mail, please check here____
	Internet address__________________________
	
	If you want your registration faxed to you, please check here____
	Fax number__________________________
        
    You may pay by check, money order, VISA, MASTERCARD, AMEX, or JCB card.

    Credit card orders may be placed
     	On Freedom City BBS (520)747-5415
     	Faxed to (520)747-5415
	Mailed to the above address.

        Credit card type: __VISA __MASTERCARD  __AMEX  __JCB
        Credit card number: ________________________________
        Expiration date: _______
        Name as it appears on card:_________________________

        All credit card orders are processed through :
        DRAGON BUSINESS SERVICES
        New Vienna, OH

        DRAGON BUSINESS SERVICES is the name that will appear 
        on your monthly statement.
