(This form is provided for your convenience; it isn't required)


    Name: ____________________________________________________________


    Address: _________________________________________________________


             _________________________________________________________


             _________________________________________________________


    =====Fido Nodes Only=====
    Fidonet Address:         _________________________________________

    Do you want to Freq the registration from 1:380/16?      [ Y / N ]

    Session Password:        _________________________________________
    ==================================================================


    Where you got FM: ______________________________ Version: ________


    Preferred media:                ___ 5-1/4"               ___ 3-1/2"


      _____ personal-use registration(s)    X    $35.00 ea. US

      _____ commercial-use registration(s)  X    $75.00 ea. US

      _____ shipping outside continental US X    $ 5.00 ea. US
                                                 -------------

      _____ total registrations                 $__________ US enclosed


    Commments/Suggestions (include separate sheet if desired):


    _________________________________________________________________


    _________________________________________________________________


    _________________________________________________________________


    Mail to:                  Mark Kimes
                              542 Merrick
                              Shreveport, LA  USA  71104