[misc.handicap] CBFB_BOOKS member.frm

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.
-----------------------------------------------------------------
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: