PortCheck 1.0 Registration Form
                         -------------------------------

                                       by
                                  Ron Reynolds

                         Copyright © 1993 Ron Reynolds
                              Freely Distributable
                                   ShareWare
                                FIDO 1:153/957.0
                       InterNet Ron_Reynolds@amsbbs.bc.ca


        NAME:    _____________________________________

        ADDRESS: _____________________________________

                 _____________________________________

        COUNTRY: ________________________

        NET ADDRESS: ________________   ( ) Fido   ( ) Internet

        BBS NAME:______________________________

        All registrations MUST be in one of the following forms.  All
        checks to be made payable to Ron Reynolds.  No exceptions.

        *   POSTAL money order
        *   US bank money order
        *   Canadian money order
        *   Cash in US bills


        for the amount of $10.00 (US), unless you are Canadian then I'll
        accept Canadian funds.

        Please check the way you want to receive your license.

        *   Please netmail my keyfile to:
            (US/Canadian Fidonet nodes only)

        *   Please mail my keyfile to the above internet address.

        *   Please mail my keyfile to the above address.
            (Please type all address' for clarity.  Be sure to include
             a proper and complete mailing address.)

       Send to:

       Ron Reynolds
       15359 87A Ave.
       Surrey B.C. Canada
       V3S-5E8