	MOD Script V1.0 REGISTRATION FORM
	===================================          DATE : [   /   /   ]

	NAME : [                                                        ]

	STREET & NUMBER : [

	                     ]  PHONE NUMBER (optional) : [             ]

	CITY : [             ]  STATE : [    ]  ZIP CODE : [            ]

        COUNTRY : [                                 ]
        _________________________________________________________________

	WHERE DID YOU OBTAIN THIS PROGRAM ? [                           ]

	USE BACK OF THE SHEET FOR ANY COMMENTS OR SUGGESTIONS, THANK YOU.
        -----------------------------------------------------------------

        CUSTOM TEXT FOR YOUR REGISTERED PROGRAM (MAXIMUM OF 20 CHARACTERS)

	: [                                                              ]

						 MARK WHERE
					         APPLICABLE

	BASIC REGISTRATION                   $10 :  [  ]   $.......
        S&H OUTSIDE CANADA AND U.S.          $5  :  [  ]   $.......

	      			  TOTAL AMMOUNT ENCLOSED : $.......

        SELECT ONE:
        REGISTERED VERSION ON DISKETTE:           3( )  5( )  

        THANK YOU FOR REGISTERING MODScript V1.0 !
