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.) |
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Acceptable forms of payment are: Check, Money Order, Purchase
Order, Cash, Mastercard or Visa.
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P. O. NUMBER:
CREDIT CARD TYPE:
CREDIT CARD NUMBER:
EXPIRATION DATE:
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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.
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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: