 
                         DUPE NUKEM Registration Form

Name _________________________________________________________________________

Address ______________________________________________________________________

City ________________   Province/State ___________   Postal/Zip Code _________

Country _________   Phone # - Voice ___________________ Data _________________
                                                   
How would you like your key sent?  (As soon as Cheque clears... 8) )
        
        (  )  Postal Mail    -    (  ) 3-1/2 inch     (  ) 5-1/4 inch Diskette
                             (* Please add $5 P&H *)
        (  )  Fido Crash/Netmail  - Address:
        (  )  Internet UUEncoded  - Address:
        (  )  Download from my BBS  (Will be available under your FULL NAME)
                  Password for your account:_________________

NOTE:  Please be sure to make out Cheque or M.O. (preferably), for $15, to:

       ALLEN WALKER, P.O. Box 5874,  Victoria, B.C, Canada,  V8R 6S8

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   If you want to pay for the door by VISA, I will need the following info:  
    (You can also do this online on my BBS, for "instant" registration...)   
                                                                             
 Name (exactly as on Card): ________________________________________________ 
                                                                             
 Visa Number: __________________________________    Expiry date: ___________ 
                                                                             
   Since the VISA is charged in Canadian Funds, the following amounts apply: 
                                                                             
                          Canadian Orders:  $15.OO                           
                          U.S.     Orders:  $19.OO                           
                                                                             
                         Postage & Handling:  $5.OO                          
         (P&H only applies to me mailing you your Registration & Disk)       
                                                                             
                         Total Charge: $___________                          
                                                                             

Comments/Suggestions:

                                                                              

