================================================================= REVEILLE / REVEILLE TIMER REGISTRATION FORM Name of Registered User (if Individual License): _________________________________________________________________ Name of Registered Institution (if Site License): _________________________________________________________________ Name and Mailing Address: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ City ______________________________ State ________ ZIP _________ Diskette Size Desired : 3-1/2"_____ 5-1/4"_____ Amount Enclosed (please circle the proper amount) : $17.95 - Separate Reveille Individual License ($12.95 + $5) $14.95 - Separate Reveille Timer Individual License ($9.95 + $5) $24.95 - Combined Individual License (for both) ($19.95 + $5) $54.95 - Separate Reveille Site License ($49.95 + $5) $34.95 - Separate Reveille Timer Site License ($29.95 + $5) $64.95 - Combined Site License (for both) ($59.95 + $5) =================================================================