Registration Form
for Subliminal Message Generator



   Name :______________________________________________________
   
   Address :___________________________________________________
   
   City,State,Zip  :___________________________________________
   
   E-Mail  :___________________________________________________
   
   
   
   Would you prefer your Registration Number be e-mailed? Y / N
   
   
   Where did you find this program : __________________________
   
   
   Comments / Suggestions  :___________________________________
   
   ____________________________________________________________
   
   ____________________________________________________________
   
   
   
   Send $10.00 ( Texas residents add $.83 sales tax) to :
        
        Oirck Software
        17610 Midway Rd. # 134-116
        Dallas, TX  75287-6799
   
   Add $5.00 ( TX : $5.41 ) if you wish to receive a disk.
   
    ( circle :   1.44 MB 3.5 inch   or    1.2 MB 5.25 inch )