Segraves Form Filler
Registration Form

When you have finished filling out the form below, please click on the "Create FDF" button. The server to which the data is sent does not save the data. You must save the FDF file that is returned to your browser and submit same to the Author's email address as an email attachment in order to perfect your registration. Alternatively, if your browser displays the data on the screen, you may simply forward the HTML page with the FDF data displayed in it to the same email address.

Please provide the following information about your SAR affiliation:

Chapter:

State Society:

National Number:

State Number:

Please provide the following information about yourself:

First Name:
Middle Name:
Last Name:
Street, R.D. or P.O. Box:
City:
State:
9-digit Zip Code:
Telephone:
E-Mail Address:

On submitting this request to the Author at the below email address, the Registrant is authorized to use the Segraves Form Filler(s) on a trial basis and agrees that the Author assumes no liability which might arise out of the Registrant's use of the form(s). The trial use of the form(s) may be terminated at a future date (TBD) without advance notice, after which a reasonable charge for use of the form(s) may be made.

Note that the registrant will not be able to use the PDF application form until the Author receives the registrant's form data and responds with a password and instructions.

Questions? Comments? Please contact the Author at . Thank you for your support.

Revision History: / 13Mar2001 - Original issue / 23Mar2001 - Enhanced return links / 26Mar2001 - Enhanced registration instructions / 27Apr2001 - Eliminated HTML registration form with Mailto: submit method / 27Apr2001 - Added enhanced HTML registration with new form data submit method / 22Sep2001 - End of trial period. Changed to "free" use for registered users. / 05Aug2002 - E-mail links removed / 05May2006 - Updated return links to NSSAR web site / 15Jul2006 - Down for maintenance / 19Aug2006 - Returned to service / 27Feb2007 - Counter added / 27Feb2007 - Trial period started for new iText-generated Universal PDF form / 27Feb2007 - License terms expanded / 18Feb2008 - incorporated suggestions from Gordon Woodard - Thanks, Gordon. /

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Segraves Form FillerRegistration Form

Segraves Form Filler
Registration Form