  --------------------------
    Lcom Registration Form
  --------------------------




  (please print)





  NAME:        _______________________________________________
               (last, first, middle initial  /or organization)


  MAILING
  ADDRESS:     _______________________________________________
               street

               ___________________________ _____ _____________
               city                        state           zip


  NUMBER OF
  TERMINALS:   ________
               (blank is assumed 1)


  LCOM VERSION:  2









  ----------------------------------------------------------------------------

  Include with this form your registration fee ($25 for the first terminal,
  $10 for each additional terminal [call (714) 588-3097 for high volume
  licensing ( 100+ ) ]  (cash/check accepted)

  Payable to:

      John Bushnell
      P.O. Box 5492
      San Clemente, CA. 92674-5492

  Your personalized registration code will be sent to you, through the mail,
  to the address you put on this form.


