                  Phantom Teleconference System
                        Registration Form


     Please fill out all of the below information.  Please print,
and be case sensitive in your name, as it will reflect your
registration number.  Once the form is completed, please mail it
along with your registration fee to the below address.


First Name:____________________  Last Name:______________________

Address:_________________________________________  Apt:__________

City:_______________________  Province:__________  Zip:__________

Voice Number:__________________  Fax Number:_____________________

BBS Name:______________________  Your Alias:_____________________

Number Of Nodes:______  Baud Rates (min & max):__________________

BBS Numbers:_____________________________________________________

Registration Type (check one):

          [ ]  1- 5  Nodes $ 35.00   [ ]  6-16 Nodes $ 60.00
          [ ] 17-32  Nodes $ 80.00   [ ] 33-64 Nodes $ 90.00
          [ ] 65-100 Nodes $120.00   [ ] 100 + Nodes $200.00

Disk Size Preferred (check one): [ ] 3.5"  or  [ ] 5.25"
            Density (check one): [ ] High  or  [ ] Low

Please specify information on the system or network that PHTConf
is to be used on:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Send this form along with a cheque or money order to:

                        Phantom Software
                      Attn: Brian Altenpohl
                   17 Van Order Drive  #6-301
                   Kingston, Ontario  K7M-1B5

Make all cheques and money orders payable to Brian Altenpohl.
     Please sign below if to your knowledge the above information
is correct.

                                   ____________________________
                                          Your Signature