Steve Jackson
412 S. Willaman Dr. #504
Los Angeles, CA 90048
U.S.A.

                              
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                REGISTRATION FORM FOR THE WEB MEDIA PUBLISHER 2.6
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           Name: ___________________________________________

   Company Name: ___________________________________________

        Address: ___________________________________________





   Phone Number: ___________________________________________

 E-Mail Address: ___________________________________________
                          

Additional comments, etc:

____________________________________________________________

____________________________________________________________

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Registration fee is $25 per copy. 
(International checks add $5).
Send this order form (or same information) along with your payment to: 

Steve Jackson  
412 S.Willaman Dr. #504 
Los Angeles, CA 90048