		 ROGE'R SOFT, S-RETRISS REGISTRATION FORM
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						       DATE : ...........


	NAME : ..........................................................

	STREET & NUMBER : ...............................................

	..............................   APT.# / SUITE : ................

	CITY : ..........................................................

	STATE : ......     ZIP CODE : ...............

	PHONE NUMBER (optional) : ...................


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	COMPUTER TYPE : .................................................

	MOUSE : YES( )   NO( )

	GRAPHIC CARD :  VGA( )   IBM 8514( )    SUPER-VGA( )

	GRAPHIC CARD BRAND AND MODEL : ..................................

	DISKETTE : 3( )    5( )

	HOW WOULD YOU GRADE S-TETRIS (0-LOWEST, 10-HIGHEST) : ...........

	ANY COMMENTS OR SUGGESTIONS ? ...................................

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	SIGNATURE : .................
