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REGISTER.FRM
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1992-01-17
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┌───────────────────────────────────┐
│ WGM-DMS v.3.5 Registration Form │
└───────────────────────────────────┘
Send to: Wayne G. Maas
880 Farmington Avenue
Apartment #202
West Hartford, CT 06119
Qty Item Price
___ Registration only (you will receive a
letter with your registration code)....... $15 each $________
___ Registration and disk with latest version
of WGM-DMS................................. $20 each $________
Check one: [ ] 5.25" disk [ ] 3.5" disk
TOTAL $________
Please make check or money order
payable to : Wayne G. Maas
Please fill in the following information completely:
Name:_____________________________________________________
Address:_____________________________________________________
City/State/Zip:_____________________________________________________
Voice Phone:_____________________________________________________
BBS Name:_____________________________________________________
BBS Phone:_____________________________________________________
PCBoard Version:_____________________________________________________
┌────────────────────────────────────────────────────────────────────┐
│Do not write below this line. │
├────────────────────────────────────────────────────────────────────┤
│Date received:____________ Serial Number: ________ Date Sent: ______│
└────────────────────────────────────────────────────────────────────┘