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                  DuTrimenu Extender Registration Form                   
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  Sysop Name:_____________________________________________               
                                                                         
  Voice Phone:(____)_____-__________                                      
                                                                          
  BBS   Name:_____________________________________________               
                                                                         
  BBS  Hours:_______      BBS Phone :(____)____-_________                
                                                                         
  Mailing Address:                                                       
                                                                         
  _____________________________________________________________________  
                                                                         
  _________________       __________        ________________             
  City                    State             Zip Code                     
                                                                         
  Version Number:_________                                               
                                                                         
  Type of Computer you have:___________________________________           
                                                                          
                                                                          
                DuTrimenu ($15.00):_________                             
                                                                         
                Send Disk ($3.50) :_________                             
                3.5" Disk with                                           
                latest version and                                       
                key (Optional)                                           
                                  ____________                           
                                  Total Cost                              
                                                                          
      Your Signature:___________________________________                 
                                                                         
                                                                         
                    <US Currency>                                        
                Send Check,Cash,or Money Order to:                       
                                                                         
                  Josh Temkin                                            
                  1701 W St. Mary's Road                                 
                  Suite A-165                                            
                  Tucson Az 85745                                        
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