Registration Form

EMAIL ADDRESS:___________________________________________

NAME:____________________________________________________
ADDRESS:_________________________________________________
	_________________________________________________
	_________________________________________________
CITY:________________________ STATE:____ ZIP:____________
COUNTRY:____________

PHONE # (Data):  ___ ____ ______________
	(Voice): ___ ____ ______________

General info:

Machine type:  8088/6[_]  80286[_]  80386[_]  80486[_]  Other[_] 
Machine name: ________________________________________

Display type:  MDA[_]  CGA[_]  Herc[_]  EGA[_]  MCGA[_]  VGA[_]  SVGA[_]
Card name:_____________________________________________

Floppy drives:    3« 720k[_]  3« 1.44M[_]  3« 2.88M[_]
		  5¬ 360k[_]  5¬ 1.2M [_]


Modem speed: 1200[_]  2400[_]  4800[_]  9600[_] 19200[_] Other: ________
Modem name:_____________________________

Other configuration:_________________________________________________
		    _________________________________________________
		    _________________________________________________
		    _________________________________________________
		    _________________________________________________

Driver type:	Svga 32768   ____	@ $20
		Svga 256     ____	@ $20
		Svga 16      ____	@ $20
		Tweak 256    ____	@ $20
		Tweak 16     ____	@ $30

		Two drivers  ____	@ $30 (check above)
		Three 	     ____	@ $40
		Four	     ____	@ $50
		Five drivers ____	@ $60

Do you want a copy of the source? _____

From September 1-May 8, please send checks/money to:
	Jordan Hargrave
	1000 Morewood Ave, Box #3277
	Pittsburgh, PA 15213
	(412) 268-4493

From May 8-September 1, send to:
	Jordan Hargrave
	1615 Burnley Road
	Charlotte, NC 28210
	(704) 553-2332