

***************** Action BBS MEMBERSHIP INFORMATION *******************

TO APPLY:  a) Fill out this form completely
           b) Make your check or money order payable
              to BOB BRINSFIELD
           b) Send check or money order for the appropriate
              amount to:   Bob Brinsfield
                           309A S. Morris Ave.
                           Crum Lynne,PA 19022

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NAME:___________________________________________________________________

ADDRESS:________________________________________________________________

CITY:______________________________ STATE:_____ ZIP CODE:_______________

VOICE PHONE #:(____)______-__________

BIRTH DATE: ____/____/____

                         [  ] Annual Member -- $25.00
                         [  ] Adult Access -- $35.00
	                 [  ] Life Time Membership -- $50.00
			 	
   If you send this back before March 1st 1994 the prices are as follows:

                        [  ] Annual Member -- $15.00
                        [  ] Adult Member  -- $25.00
                        [  ] LifeTime Membership -- $40.00

     This will entiltle you to 1 1/2 years membership. Good till 9/6/95.

                               Or try this
                 [  ] Temporary Access 3 months only $5.00
                   Photo Id required for all adult access  
                                                   
     These are the last Special offers we will make so don't miss out!

I hereby request membership in Action BBS.  I attest that all information
provided is true to the best of my knowledge, and that I will abide  by all
rules and regulations of the board.

*  You MUST attach PROOF OF AGE
   in order to receive access to Adult conference.  This conference is
   restricted to those 18 years of age or over.  Acceptable "Proof of Age"
   is a photocopy of your driver's license or birth certificate.


*  You can now also specify where you would like your money to go. There
   are several doors that need to be registered for example.

      [ ]  Super slots              [ ] Studs!
      [ ]  Rescue                   [ ] Studette!
      [ ]  Food Fight               [ ] Bordello
      [ ]  Timedoor                 [ ] Fantasy Board
      [ ]  BBS Bowl                 [ ] Fantasy Land            

      Just check the appropriate box and your name will be posted as
      having registered the door.


Signature  X___________________________________  Date:_____________

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I will attempt to process all applications as quickly as possible.  Once
your application has been received, your security level will be upgraded
immediately.



