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  1.                          TAKE FIVE REGISTRATION
  2.                          ----------------------
  3.  
  4.     To register your copy of Take Five please fill out the following
  5.     and send it along with a check or money order to:
  6.  
  7.                              David Gross /T5
  8.                              P.O. Box 621331
  9.                             Orlando, FL 32862
  10.  
  11.  
  12.  
  13.     Name for registration:______________________________________
  14.  
  15.                   Address:______________________________________
  16.  
  17.                           ______________________________________
  18.  
  19.                           ______________________________________
  20.  
  21.  
  22.                      Date:___________
  23.  
  24.  
  25.  
  26.     QUANTITY: _____  x  $20 =  ________ TOTAL
  27.  
  28.     
  29.     For quantities of five (5) or more the price drops to $15 per
  30.     copy.
  31.  
  32.  
  33.     COMMENTS:
  34.  
  35.          ___________________________________________________________
  36.  
  37.          ___________________________________________________________
  38.  
  39.          ___________________________________________________________
  40.  
  41.          ___________________________________________________________
  42.  
  43.          ___________________________________________________________
  44.  
  45.  
  46.  
  47.     Where did you get Take Five? ___________________________________
  48.  
  49.  
  50.  
  51.     (Please include check or money order payable in US currency)
  52.  
  53.