UsageLog Registration Form
                          Version 1.3 (April 14, 1991)

        Name:  __________________________________________________________

        Address:  _______________________________________________________

        City:  ___________________  State:  _______  ZIP Code: __________

        Voice phone number (optional):  (_____) _____ - __________

        Name of BBS:  ___________________________________________________

        BBS Software:  __________________________________________________

        Phone number of BBS:  (_____) _____ - __________

        Select either  ____  3 1/2" disk   or   ____ 5 1/4" disk

        Would you like a 286-specific version?  ____ Yes   ____ No

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        Send  this form, along with your check or money order  (no  cash,
        please) for $10, to:

        Brian Piersel
        227 Santee Pass
        Brookings, SD  57006-3722

        I do not accept any credit cards orders.
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        Comments:

























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