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  1.                           MI-RIP REGISTRATION FORM
  2.  
  3. NAME:     ______________________________________________________________
  4.           Above name will be used for registration name!  Please Print
  5.  
  6. ADDRESS:  ______________________________________________________________
  7.  
  8. CITY:     ______________________________________________________________
  9.  
  10. STATE:    __________  ZIP CODE:  _________________
  11.  
  12. PHONE:    _(_____)______________________________________________________
  13.  
  14. WHERE DID YOU RECEIVE MI-RIP FROM?  ____________________________________
  15.  
  16. COMMENTS: ______________________________________________________________
  17.  
  18.           ______________________________________________________________
  19.  
  20.           ______________________________________________________________
  21.  
  22. RIME Node Number: _______________
  23.  
  24. Basic Registration @ $25.00 for version 1.05         $__________________
  25.  
  26.      $1.00 extra for 3½" disk needed for update      $__________________
  27.  
  28.                                             TOTAL:   $__________________
  29.  
  30. Remit to:                 John M. Haro
  31.                           P.O. Box 13031
  32.                           Omaha NE 68113-0031
  33.  
  34.  
  35.