
Name (please print)______________________________________________

Address _________________________________________________________

        _________________________________________________________

        _________________________________________________________
  
City    _________________________________________________________

St./Prov. _______________________________________________________

ZIP/PostCode ____________________________________________________

Country _________________________________________________________

Phone/Fax _______________________________________________________

E-Mail __________________________________________________________


Thank you for your registration fee!
Please make cheques payable to "Derek Smith".

Send to:

	Derek Smith,
	Kalfstrasse 68a,
	52159 Roetgen,
	Germany.


Where did you obtain 'Fizzy Fractals' ?

  [ ] CompuServe
  [ ] America Online
  [ ] Other BBS -- Please write name:
  [ ] Internet site -- Please write name:
  [ ] Shareware catalogue -- Please write name:
  [ ] Work, a friend or a relative
  [ ] CD-ROM disk
  [ ] Other:_____________________________________________________


What do you like/dislike about 'Fizzy Fractals' ?

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Suggestions about 'Fizzy Fractals' ?

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Once again, thank you!
