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Gra MałysZ !!!!! ORDERENG
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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