CHAT DOOR REGISTRATION FORM

          Registration of CHAT is $10.00. Payment is to be
          made in U.S. funds only. Please answer all of the following
          questions.

          Name_________________________________________________________

          Address______________________________________________________

          City_____________________State__________________Zip__________

          BBS Name_____________________________________________________

          BBS Phone Number_____________________________________________


                     THANK YOU FOR REGISTERING CHAT

          Mail to:

          Dale Freeman
          P.O. Box 813
          Dover, AR 72837-0813