Avatar Systems, Ltd.

Registration Form Sample.

Location: 123 Main St, Anywhere, XX 99999.

Registration Deadline: February 30, 2000.

---

First Name:
Last Name:
Title:
Company:
Address:
City:
State:	Alabama Alaska Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Zip/Postal Code:
Telephone:
Fax:
E-mail:

Are you (or is your organization) a member?	Yes     No
Please check all functions you will attend:
Annual Meeting (9:00 am - 10:00 am)
Forum (10:15 am - 1:00 pm)
Luncheon (1:00 pm - 2:00 pm)