                	   VGA Lunar Lander V1.0     
			     Registration Form



First Name     :___________________________________________


Last Name      :___________________________________________


Address        :___________________________________________


City           :___________________________________________


State/Province :___________________________________________


Zip/Postal Code:___________________________________________


Phone Number   :(___)______________________________________


Name of BBS or Vendor where VGA Lunar Lander was obtained from:

_______________________________________________________________


Computer       :  [ ] XT  [ ] 286  [ ] 386  [ ] 486  [ ] Other

Disk Type      :  [ ] 5 1/4     [ ] 3 1/2

Disk Capacity  : _____________


Amount enclosed:_____________________________________
(send what you think it is worth)

Source code in return (only if you send $35 or more)        [ ] Yes


Make cheque payable to Chris Egerter and mail to the address below.


                          Chris Egerter
                          94 Andover Drive.,
                          London, ONT.
                          Canada
	                  N6J 3X2


