Wildtick REGISTRATION Form

TO:   Lawrence Gordon
      4 Waverton Drive
      St. Louis, MO  USA  63124

      FIDONET 1:100/560

Your Wildtick license entitles you to use all FUTURE UPDATES FREE.

Please find enclosed my registration fee of $10.00 

        by [ ] cash, [ ] check, [ ] money order in US funds.

        Date: _____/_____/_____ (mm/dd/yy)

    BBS Name: ____________________________________________

  Users Name: ____________________________________________

Mail Address: ____________________________________________

 City, State: __________________________________(________)

 Voice Phone: ____________________________________________

Data Phone -or- Fido Address:   __________________________

CURRENT Wildtick VERSION:    _______________________________



                   Yours truly,




                  ___________________________________