Yes, I want to register as a user of MusiPoc 1.20.

Name: _________________________________________

Address: ______________________________________

Town: ____________________________ State: ____   ZIP: ____

Country: ______________________________________


I have obtained MusiPoc through:

        _  an electronic network or bulletin board

           Please give name of network __________________

            and your ID _______________

        _  through a shareware organisation

           Please give name of organisation __________________

        _  from a dealer

        _  from a friend

        _  Other

I use MusiPoc for:

        _  business purposes

           Please indicate nature of business _____________________

        _  personal purposes

        _  as software developer


Optional:

I have added the amount of US$ 10.00 in the form of

        _  a personal cheque (Australia only)

        _  a cheque made payable to an Australian bank

        _  Eurocheque(in the currency of my country)

        _  money order


Signature ____________________________    Date _______________