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  1.  
  2.  
  3.                                       MQM V1.00
  4.                                   REGISTRATION FORM
  5.                                   -----------------
  6.                                    (Please Print)
  7.  
  8.  Registered to: _______________________________________                       
  9.  
  10.  First Name : ____________________________  Last Name: ______________  MI: ___ 
  11.  
  12.  Address: _________________  City: ___________  State: ___ Postal Code:_______
  13.  
  14.  Country: __________________ Home Phone: ( ### ) ###-#### 
  15.                              Business  : ( ### ) ###-####
  16.  
  17.  WHAT SIZE DISK DO YOU WANT THE PROGRAM SENT ON?:    3½   or   5¼
  18.  
  19.                                                    (Please circle one)
  20.  
  21.                 USA or CANADA                            FOREIGN
  22.                 ~~~~~~~~~~~~~~~~~                    ~~~~~~~~~~~~~~~~
  23.                 MQM     : $ 15.00                    MQM    : $ 20.00
  24.  
  25.       Ontario Residents
  26.       please add 15%
  27.       sales tax         : $    
  28.  
  29.        TOTAL            : $                           TOTAL  : $______
  30.  
  31.  
  32.       Please specify if you wish to download MQM upon recipt of your order from
  33.       our support BBS:
  34.  
  35.       Valhalla BBS (519) 433-5122 (8N1 - 9600 v.32/v.42BIS, MNP 2-5) (ATI etc/e)
  36.  
  37.  
  38.    PAYMENT BY CHECK OR MONEYORDER:
  39.  
  40.            Make out a check or money order in Canadian funds for the total and
  41.            mail it with this form to the following address:
  42.  
  43.                                Matt Duƒresné
  44.                                336 Highview Avenue East,
  45.                                London, Ontario  
  46.                                CANADA
  47.                                N6C 5G8
  48.  
  49.  
  50.