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|   KWQ Mail/2 Registration Form, Version 1.2d                               |
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|   Please send your registration information (this form filled out) and     |
|   a check or money order for $25 to the following address:                 |
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|                       Kurt Westerfeld                                      |
|                       7935 Tyson Oaks Circle                               |
|                       Vienna, Virginia 22182                               |
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|   Please make all checks out to "Kurt Westerfeld."                         |
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|   Virginia residents add 4.5 percent sales tax ($25.00 + $1.13) = $26.13.  |
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|   International orders can only be accepted if checks are drawn on an      |
|   AMERICAN bank.  Sorry, support for foreign currency is limited.          |
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|   Your Name:   _______________________________________________________     |
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|   Address:     _______________________________________________________     |
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|                _______________________________________________________     |
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|   City:        ________________________________  State: ______________     |
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|   Zip or Postal Code:  _________________      Country:  ______________     |
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|   OPTIONAL:  (To be used in case of support needs)                         |
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|   Home Phone:  ____________________   Work Phone:  ___________________     |
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|   Email:       _______________________________________________________     |
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|   The following information is optional and will only be used for          |
|   interesting tidbits of trivia:                                           |
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|   Are You a Sysop of a BBS?   Yes __ No __       Phone:  _____________     |
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|   How long have you used OS/2?  ____________                               |
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|   How did you hear about KWQ Mail/2?:    _____________________________     |
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|   ____________________________________________________________________     |
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|   Where did you get a copy of KWQ Mail/2?:    ________________________     |
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|   ____________________________________________________________________     |
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|   Do/did you use a DOS-based reader?   Yes __ No __  Which? __________     |
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|   Suggestions:                                                             |
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