Deluxe Ski Jump Registration Form Name : _______________________________________________ Address: _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ E-mail : _______________________________________________ Deliver the registration key via: [ ] mail [ ] e-mail Registration fee: [ ] Australia 10 AUD [ ] Italy 15000 ITL [ ] Austria 100 ATS [ ] Japan 1000 JPY [ ] Canada 12 CAD [ ] Norway 60 NOK [ ] Czech Republic 300 CZK [ ] Poland 30 PLN [ ] Denmark 50 DKK [ ] Sweden 70 SEK [ ] Estonia 120 EEK [ ] Switzerland 12 CHF [ ] Finland 40 FIM [ ] The Netherlands 15 NLG [ ] France 50 FRF [ ] USA 8 USD [ ] Germany 15 DEM [ ] United Kingdom 5 GBP [ ] Other countries 8 USD / 15 DEM / 40 FIM Type of payment: [ ] Cash payment enclosed (no cheques) [ ] Bank transfer (Please enclose the receipt) Pay To : Mr. Jussi Koskela Bank : Keski-Uudenmaan Osuuspankki Kerava, Finland Account : 513205-246434 Date and Signature: ____________________________________ ======================================================== Send this form enclosed with the cash payment or bank receipt to: "DSJ" Mediamond Tmi Kaenkatu 4 B 20 04230 Kerava Finland Please allow 1-10 days for delivery. Inquiries: jussi.koskela@mediamond.fi
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