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  1.                       WORD CONVERTER REGISTRATION FORM
  2.  
  3.      To  register Word Converter, fill out this form and email it to:
  4.                             docent@union.org.pl
  5.  
  6.    or print out and mail it filled, together with the registration fee (see
  7.    below) to the address:
  8.      
  9.                                Peter Drapich
  10.                              ul. Karowa 18a/20
  11.                                00-324 Warsaw
  12.                                    Poland
  13.  
  14.       
  15.    I  have  tried  the  evaluation  version  of Word Converter, and wish to
  16.    register it. Please send me the registered version, personalised for:
  17.  
  18.    Your Name or Company Name   ______________________________
  19.  
  20.    Your Name                   ______________________________
  21.  
  22.    E-Mail                      ______________________________
  23.  
  24.    Address                     ______________________________
  25.  
  26.                                ______________________________
  27.          
  28.                                ______________________________
  29.          
  30.    Phone (optional)            ______________________________
  31.  
  32.    Platform (tick, where appriopriate)    Amiga [ ] Linux/SGI/Win95 [ ]
  33.  
  34.  
  35.                       I'll pay for Word Converter for
  36.  
  37.         [ ] Amiga            [ ] Linux/SGI/Win95
  38.         [ ] UK £10             [ ] UK £20
  39.         [ ] US $15            [ ] US $30
  40.         [ ] DM 30            [ ] DM 60
  41.         [ ] PLN 25 (only Poland)    [ ] PLN 50 (only Poland)
  42.  
  43.                      ! Use the proper column to tick !
  44.  
  45.                  Delivery by mail (including floppy disk):
  46.  
  47.                 [ ] UK £3
  48.                 [ ] US $5
  49.                 [ ] DM 10    
  50.                 [ ] PLN 5
  51.  
  52.                      ! Use the proper column to tick !
  53.  
  54. Total:              _______ [ ] UKP
  55.             _______ [ ] USD
  56.             _______ [ ] DM
  57.             _______ [ ] PLN
  58.  
  59.