          QuipSig Program Registration Form
          _________________________________




Your Name: _______________________________________

Street Address: __________________________________

City: ____________________________________________

Province/State: __________________________________

Postal Code/ZIP: _________________________________

Country: _________________________________________


email address (to send the registered program components to):

__________________________________________________



Where did you hear about this program?


Friend __________   Advertisement _________


Other (specify) __________________________________


Mail this completed form to:

Rod Carty,
29 Bates Crescent,
Whitehorse, Yukon, Canada
  Y1A 4T8


Include a money order for $10.00 in Canadian funds.
(Sorry, no credit cards or cheques accepted.)
Please do not send cash in the mail.

I will email you the registered version of the program.

If you desire the program on floppy, please include an additional
$5.00 in Canadian funds in the money order to cover cost of the
media and shipping/handling.



Thanks for supporting my efforts, and for supporting
the shareware concept.
