robertj@tekgen.bv.tek.com (Robert Jaquiss) (05/11/91)
Index Number: 15480 CBFB INDIVIDUAL REGISTRATION FORM The one-time membership fee of $25 entitles you to $40 worth of FREE computerized books and CBFB's quarterly magazine. The free books must be ordered with your registration. To join, please complete and return this form with payment to: Computerized Books for the Blind 52 Corbin Hall University of Montana Missoula, MT 59812 Phone: 406/243-2899 FAX: 406/243-2349 InterNet Email Address: cbfb_gwk@umt.umt.edu NAME: ADDRESS: CITY: STATE: ZIP: COUNTRY: DAYTIME PHONE: Email system and address: DISABILITY VERIFICATION Please have your Doctor, Counselor, or Employer write a short statement verifying that a disability exists or list your RFB identification number: Signature___________________________________Date_________________ Organization_____________________________________________________ COMPUTER EQUIPMENT Please provide the following information about your computer: Make and Model (check that which applies): IBM XT_______ IBM AT_______ IBM PS/2 and Compatible_______ APPLE II_____ MACINTOSH_____ VERSABRAILLE II_____ EUREKA_____ OTHER(specify)_____ Type of Disk Drive and Disk Density (check all that apply): 5.25 inch ______ 3.5 inch ______ Hard Disk Drive _____ Double Density Disks _____ High Density Disks ______ CBFB LICENSING AGREEMENT CBFB's ability to provide electronic materials depends on member cooperation. The materials provided are donated to CBFB by the publishers. In return, CBFB agrees only to duplicate materials for distribution to verified print-disabled members of CBFB. CBFB members agree to the following terms: 1. CBFB grants you a paid-up, non-transferable, personal license to use materials received from CBFB on one microcomputer or workstation. You may personally use the electronic book on another microcomputer or workstation as long as the book is not used on more than one machine at a time. 2. Members may NOT make copies of the electronic books to distribute to other individuals, organizations or CBFB members. The books received from CBFB are intended only for the personal use of the verified print-disabled licensed member. 3. CBFB grants you the right to make a backup or archival copy of the electronic book. 4. CBFB DOES NOT grant the use of the books in any manner other than stated in this agreement. 5. CBFB will replace, at no charge, defective materials that are returned within 90 days of the original date of purchase. 6. Other than the limited warranties stated in this agreement, CBFB MAKES NO OTHER IMPLIED WARRANTIES OF MERCHANTABILITY OR WARRANTIES OF FITNESS FOR A PARTICULAR PURPOSE. 7. You are legally accountable for any violation of this License Agreement or of Copyright, Trademark, or Trade Secret Laws. If you agree to these terms, please sign and date this agreement. Signature_________________________________Date___________________ REGISTRATION BOOK ORDER FORM NAME OF BOOK | AMOUNT ------------------------------------------------------|---------- 1. 2. 3. 4. 5. LESS $40 OF FREE BOOKS ($40) BOOKS SUB-TOTAL (not less than zero) REGISTRATION FEE $25 ______________________________________________________|__________ TOTAL ENCLOSED (In U.S. Currency Please.) | ----------------------------------------------------------------- Acceptable forms of payment are: Check, Money Order, Purchase Order, Cash, Mastercard or Visa. ----------------------------------------------------------------- P. O. NUMBER: CREDIT CARD TYPE: CREDIT CARD NUMBER: EXPIRATION DATE: ----------------------------------------------------------------- CBFB grants fee waivers upon request for individual members. Please use the form provided in the file called WAIVER.FRM when requesting a fee waiver. ----------------------------------------------------------------- POTENTIAL USERS Do you know someone who could use CBFB's services? If you do, please complete the following information and CBFB will send them an Information Packet. NAME: ADDRESS: CITY: STATE: ZIP: COUNTRY: PHONE NUMBER: MAKE OF COMPUTER AND DISK DRIVE SIZE: Special notes or comments: