Please register my copy of Birthlis. I am sending a check or money order for the amount of 
$49.00.

Name:________________________________________________________________

Company:_____________________________________________________________

Address1:____________________________________________________________

Address2:____________________________________________________________

City:_____________________State:____Zip:_________________

Country:__________________________

Tel:______________________Fax:___________________________

Email:___________________________________________________


Single-User Registration

Single user...................................................$49.00

Multi-User Registration (Site license)

10 to 20 users...............................................$400.00
21 to unlimited	.............................................$700.00
	
Amount enclosed	....................................................

Send completed form with payment to

	John Hickey
	8396 Capricorn Way #52
	San Diego Ca 92126

Where did you here about Birthlis ?

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Notes
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