                    MATHEMATICA REGISTRATION FORM


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Instructions
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Fill out the form below (ASCII characters only, please), then send
by email or print to your fax modem.

Email address: register@wolfram.com

If received, email will be acknowledged within 24 hours. If you
do not get an acknowledgment, please resend your registration by
other means.


Fax numbers:    +1-217-398-1108    (U.S.)
               +44-(0)1993-883800  (Europe)
               +81-(0)3-5276-0509  (Japan)

Note: You can register immediately on the web at register.wolfram.com.


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Registration Form
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Important! Our system requires that this form be filled out in
English. For non-English names, use transcriptions understood by
your local postal service.  For names containing non-English or
accented characters, use the closest English equivalent.

Please give names in the following order: given name first, family
name last.

If the software is licensed to your organization, give the address of
your organization, not your home address.


Primary user 
============

(The primary user will receive upgrade and license information.)

License Number:

First Name: 

Last Name:

Company/Institution:

Job Title:

Department:

Mail Stop:

Street Address (no P.O. boxes):

City:

State/Province/Pref.:

ZIP/Postal Code:

Country:

Email Address:

Phone and Fax Numbers--Include area code (and country and city code if
outside the US) for all of the following numbers:

Work Phone:

Home Phone:

Fax Number:

In which sector are you employed?
=================================

(Place an "X" in the appropriate box. Check only one.)

[   ] Industry

[   ] College Education

[   ] Precollege Education

[   ] Government

[   ] Other:

If you are a student, please specify:

	[   ] Graduate

	[   ] College

	[   ] Precollege
	
 
What is your primary job function?
==================================

(Place an "X" in the appropriate box. Check only one.)

[   ] Consulting

[   ] Data Analysis
 
[   ] Executive
 
[   ] Management
 
[   ] Product Development
 
[   ] Production/Quality Control
 
[   ] Research, Applied
 
[   ] Research, Fundamental
 
[   ] System Administration

[   ] Teaching

[   ] Other:

 
What best describes your discipline?
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(Place an "X" in the appropriate box. Check only one.)

[   ] Biotechnology/Medicine

[   ] Chemistry

[   ] Computer Science

[   ] Engineering, Aerospace

[   ] Engineering, Chemical

[   ] Engineering, Civil

[   ] Engineering, Electrical

[   ] Engineering, Mechanical

[   ] Engineering, Other:

[   ] Finance/Economics

[   ] Mathematics

[   ] Physics

[   ] Social Sciences

[   ] Other:

 
How did you find out about this product?
=======================================

(Place an "X" in the appropriate boxes. Check all that apply.)

[   ] Advertisement in a magazine/journal/newspaper

[   ] Catalog

[   ] Educational setting

[   ] From a colleague/friend

[   ] Internet advertisement

[   ] Magazine article/Journal review

[   ] Professional conference/Trade show

[   ] Read about it in a book

[   ] Received a mailing

[   ] Software dealer

[   ] Visited/contacted by Wolfram Research staff

[   ] Web/Internet/Email

[   ] Other:

List any technical software programs besides this one that you use:
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On what computer system will you install this product?
======================================================

Operating System:

Version Number:

Technical support contact 
=========================

(if not the primary user)

The technical support contact will maintain the copy of this product and
is eligible for technical support. Please provide the following
information for the technical support contact.

First Name:

Last Name:

Email Address:
 
 
 
Requesting a password 
=====================

(when a password is required)

If the product you are registering requires a password, and if you are
unable to request a password on the web, over the internet, or on the
phone, please complete this section.

License Number: 

Machine Name (hostname):

MathID (from running MathInstaller -info):


Do you have any comments or suggestions?
========================================





 

Note: We do not sell our mailing lists.
 
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Contact Information
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Wolfram Research, Inc.
email: info@wolfram.com  
  web: www.wolfram.com
phone: +1-217-398-5151
  fax: +1-217-398-1108
 mail: 100 Trade Center Drive
       Champaign, IL 61820-7237
       USA

Wolfram Research Europe Ltd.
email: info@wolfram.co.uk
  web: www.wolfram.co.uk
phone: +44-(0)1993-883400 
  fax: +44-(0)1993-883800
 mail: 10 Blenheim Office Park, Lower Road 
       Long Hanborough, Oxfordshire OX8 8LN
       UNITED KINGDOM	

Wolfram Research Asia Ltd.
email: info@wolfram.co.jp
  web: www.wolfram.co.jp
phone: +81-(0)3-5276-0506
  fax: +81-(0)3-5276-0509
 mail: Izumi Building 8F
       3-2-15 Misaki-cho
       Chiyoda-ku, Tokyo 101-0061
       JAPAN


