Registration form for AlphaWin


Program No. : 178643


Last name	:	_______________________________________________________________

First name	:	_______________________________________________________________

Company	:	_______________________________________________________________

Street and #	:	_______________________________________________________________


City, State, postal code	:	_______________________________________________________

Country	:	_______________________________________________________________

Phone	:	_______________________________________________________________

Fax	:	_______________________________________________________________

E-Mail	:	_______________________________________________________________

How would like to receive the registration key?

e-mail - fax - postal mail


How would you like to pay the registration fee of US$ 14,95:

credit card - wire transfer - EuroCheque - cash


Credit card information (if applicable)

Credit card: Visa - Eurocard/Mastercard - American Express - Diners Club


Card holder	:	_______________________________________________________________

Card No.	:	_______________________________________________________________


Date of Expiration	:	___________________________________________________________

Date / Signature ___________________________