Registration Form:

    P R I M E   B A S E   D O O R   R E G I S T R A T I O N   F O R M

   TO:  William Rountree                           Date___/___/___
        4215 Madrona Dr. SE.
        Apt # 12-3        
        Port Orchard, WA. 98366-2745

       (Please use capitalization and punctuation where necessary.)

 FROM:  SysOp Name: _______________________________________________

        BBS Name: _________________________________________________

        Address: __________________________________________________

        City: ______________________ State: __________ ZIP: _______

        Voice: (   ) _________________ BBS: (   ) _________________

        BBS Software: _____________________ BBS Hours: ____________

        Baud Rates:________________________

SOFTWARE                          VERSION                  PRICE
--------                          -------                  -----

Adventurer's Maze.................. 1.51 ................ $15.00

Murder Mansion......................1.63 ................ $15.00

                                                           _____

(WA residents add 7.8% tax)                                _____

Total                                                    $______

                           F E E D B A C K
                           ---------------

 I learned of ADVENTURER'S MAZE/MURDER MANSION from:
           [  ] - A Friend         [  ] - Computer Club
           [  ] - BBS              [  ] - Compuserve
           [  ] - GEnie            [  ] - Other

 COMMENTS: _____________________________________________________
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