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|  VGA2CGA v2.0 Registration                       Date:                 |
|  [ ] 5.25"  or  [ ] 3.5" (add $10)                                     |
|                                                                        |
|  Name:                                                                 |
|                                                                        |
|  Address:                                                              |
|                                                                        |
|                                                                        |
|  Where/How     BBS [ ] Name/City/State :                               |
|  Acquired ?  Other [ ] Specify.        :                               |
|------------------------------------------- (Model/Manufacturer) -------|
|  Computer:                                                             |
|                                                                        |
|  Monitor:                                                              |
|                                                                        |
|  Video Card (BIOS version):                                            |
|                                                                        |
|  Other (e.g. Scanner, Video Capturer:                                  |
|                                                                        |
|  Comments: (use back)                                                  |
|                                                  Signature             |
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