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
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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. Send this order form (or same 
information) along with  your  payment to: 
Steve Jackson  412 S.Willaman Dr. #504 Los Angeles, CA 90048