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  1. _____________________________________________________________________________
  2.  
  3.  
  4. Name _________________________________________________________________
  5.  
  6. Address ______________________________________________________________
  7.  
  8.         ______________________________________________________________
  9.  
  10. City/town ____________________________________________________________
  11.  
  12. State/province _______________________ Zip/post code _________________
  13.  
  14. Country ______________________________________________________________
  15.  
  16. Daytime phone number _________________________________________________
  17.  
  18. FAX number ___________________________________________________________
  19.  
  20. Comments _____________________________________________________________
  21.  
  22.          _____________________________________________________________
  23.  
  24.  
  25.   [ ] Game Library (registration only)                       $10.00
  26.    
  27.       Select this option if you do not need a diskette
  28.       mailed to you.
  29.    
  30.   [ ] Game Library (registration + diskette, US)             $15.00
  31.  
  32.       Select this option if you need a diskette mailed
  33.       to you inside the continental United States.
  34.  
  35.   [ ] Game Library (registration + diskette, non-US)         $20.00
  36.  
  37.       Select this option if you need a diskette mailed
  38.       to you outside the continental United States.
  39.    
  40.       Diskette size:     [ ] 3½"                   [ ] 5¼"
  41.  
  42. _______________________________________________________________________
  43.  
  44.  
  45. Payment:       [ ] Check/cheque          [ ] Money order
  46.  
  47. Please make your payment, check or money order only, in US funds
  48. payable to:  Dennis E. Butler.
  49.  
  50. _______________________________________________________________________
  51.  
  52. Mail this form to:    Dennis E. Butler
  53.                       829 Riverboat Circle
  54.                       Orlando, FL 32828
  55. _____________________________________________________________________________
  56.  
  57.