WORD CONVERTER REGISTRATION FORM

     To  register Word Converter, fill out this form and email it to:
                            docent@union.org.pl
 
   or print out and mail it filled, together with the registration fee (see
   below) to the address:
     
                               Peter Drapich
                             ul. Karowa 18a/20
                               00-324 Warsaw
                                   Poland

      
   I  have  tried  the  evaluation  version  of Word Converter, and wish to
   register it. Please send me the registered version, personalised for:

   Your Name or Company Name   ______________________________

   Your Name                   ______________________________

   E-Mail                      ______________________________

   Address                     ______________________________

                               ______________________________
         
                               ______________________________
         
   Phone (optional)            ______________________________

   Platform (tick, where appriopriate)    Amiga [ ] Linux/SGI/Win95 [ ]


                      I'll pay for Word Converter for

		[ ] Amiga			[ ] Linux/SGI/Win95
		[ ] UK £10 			[ ] UK £20
		[ ] US $15			[ ] US $30
		[ ] DM 30			[ ] DM 60
		[ ] PLN 25 (only Poland)	[ ] PLN 50 (only Poland)

                     ! Use the proper column to tick !

                 Delivery by mail (including floppy disk):

				[ ] UK £3
				[ ] US $5
				[ ] DM 10	
				[ ] PLN 5

                     ! Use the proper column to tick !

Total:          	_______ [ ] UKP
			_______ [ ] USD
			_______ [ ] DM
			_______ [ ] PLN