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  1.  
  2.                                DR ANSI v1.2
  3.                              Registration Form
  4.                              -----------------
  5.  
  6.  
  7.      Please print, and use capitalization and punctuation where necessary.
  8.  
  9.      Your name is also used for registration purposes so it must be
  10.      the same as what you use on your BBS (it will be shown as the
  11.      registered person on the DR ANSI title screen).
  12.  
  13.  
  14.      Your Name:    _______________________________________________________
  15.  
  16.      Address:      _______________________________________________________
  17.  
  18.      City:         ___________________  State:  ________  ZIP:  __________
  19.  
  20.      BBS Name:     ___________________________   Fidonet Addr.: __________
  21.  
  22.      BBS Software: ___________________________ BBS S/W Version: __________
  23.  
  24.      Voice phone:  ___________________  BBS phone  _______________________
  25.  
  26.  
  27.  
  28.  
  29.  
  30.      To register your copy of DR ANSI, send a $10 check or money order
  31.      in US FUNDS ONLY to:
  32.                                 Dan Roseen
  33.                                 P.O. Box 5695
  34.                                 Kent, WA  98064-5695
  35.  
  36.      Please allow 2-4 weeks to receive your registration number.
  37.  
  38.  
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  40.  
  41.  
  42.                                 Feedback
  43.                                 --------
  44.  
  45.      COMMENTS:  _________________________________________________________
  46.  
  47.      ____________________________________________________________________
  48.  
  49.      ____________________________________________________________________
  50.  
  51.      ____________________________________________________________________
  52.  
  53.      ____________________________________________________________________
  54.  
  55.      ____________________________________________________________________
  56.  
  57.      ____________________________________________________________________
  58.