This one has a bit more than that. It includes the white blank, a black one, one with stars, plus the labels for the form and some symbols for mapping. It's not "finished" but all of the components are there. To use the jumplines, just move them into place over the starting world and then scale them out to the destination world or the edge of the map. Please let me know what you think.
M

http://dl.dropbox.com/u/8988232/subs...20template.zip