SUPER BREAKOUT REGISTRATION FORM -------------------------------- _____________________________________________________________________ IF YOU LIKE THE GAME THEN PLEASE REGISTER IT WITH ME. IN RETURN FOR REGISTERING THE GAME YOU WILL RECEIVE THE FOLLOWING: UP TO DATE GAME, 100 LEVELS, LEVEL EDITOR. ------------------------- -------------------------------------------- IN ORDER TO REGISTER SUPER BREAKOUT PLEASE EMAIL OR POST THIS FORM TO ME AT THE ADDRESS SHOWN AT THE BOTTOM OF THIS DOCUMENT: WHEN I RECEIVE THE FORM, I WILL EMAIL OR POST THE GAME TO YOU. THE COST OF THE GAME IS AS FOLLOWS: REGISTRATION COST: (Or nearest equivalent in your currency) BY EMAIL : £2.00 BY POST (UK) : £2.50 BY POST (Outside UK) : £7.00 If the order is from the UK, then please pay in cash or cheque. If the order is from abroad, then please pay in cash. Please make cheques payable to: GARY SMITH. IF ORDERING THE GAME BY EMAIL, I WILL EMAIL THE GAME TO YOU IMMEDIATELY. PLEASE MAKE SURE THAT THE PAYMENT IS POSTED TO ME THOUGH. (MAKE SURE THAT YOU ARE ABLE TO RECEIVE ATTACHMENTS OF 1.5MB !!!) -------------------------------------------------------------- YOUR ADDRESS ------------- NAME : ............................................. EMAIL : ...................................... POSTAL : .............................................. .............................................. .............................................. .............................................. -------------------------------------------------------------- MY ADDRESS ---------- EMAIL : gary.smith3@virgin.net ------------------------------ POSTAL ADDRESS -------------- Gary Smith 33 Hamilton Road Gillingham Kent ME7 1QJ