Registration Form for CoolCD Studio

Program No.: 103695

Last name (required): _____________________________________

First name (required): ____________________________________

Company: __________________________________________________

Street and #: _____________________________________________

City, State, postal code: _________________________________

Country: __________________________________________________

Phone: ____________________________________________________

Fax: ______________________________________________________

E-Mail (required): ________________________________________

How would you like to pay the registration fee:

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 __________________________________________