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Registration Form for ChaosWar                                  -
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Your Name ____________________________________________

Your Street Address __________________________________

Your City/St/Zip _____________________________________

Your Voice Telephone Number __________________________

Your BBS name ________________________________________

Your BBS Telephone or IP number ______________________

How many people can simultaneously access ChaosWar on your system?
                                  ____________

Do you want your BBS name and number to be omitted from lists
released to the public     [ ]Y     [ ]N

Do you charge users
for access to ChaosWar     [ ]Y     [ ]N

$15 US is enclosed as      [ ] Check     [ ] Money Order

In a week I will log on with my real name as given above to
Exec-PC BBS (+1 414 789 4210) to download my registered ChaosWar
copy               [ ]Y
              -or-
Enclosed is $5 extra, totalling $20, for shipping the
registered ChaosWar copy. Please send it to me on a low
density          [ ]5        [ ]3         inch disk.

Thanks for taking the time to fill this out. Feel free to 
include any comments or suggestions. Make checks payable to 
Rajib K. Mitra and mail to:

     Rajib K. Mitra
     ChaosWar Registration
     3225 Old Lantern Drive
     Brookfield, WI 53005-3014

