Registration Form for Buttons collection

Send form to 76312.2053@compuserve.com
		or
Mail to: Jeffrey M. Collins
	 1991 Park Forest
	 Lake Oswego, OR, 97034


Name:             _____________________________________________________________

Address:          _____________________________________________________________

City, State, Zip,
Country:          _____________________________________________________________

Phone Number:     _____________________________________________________________

E-mail Address:   _____________________________________________________________


Description           Quantity       Price      Total                Disk Size
								   
   Set 1               (   )          $20      ________              3.5  ( )

   Set 2               (   )          $20      ________              5.25 ( )

   Both Sets           (   )          $30      ________


Payment Method:
     
     Cashier's Check ( )  
     Money Order     ( )   
