Registration for the Amiga Summagraphic-Driver
                  ----------------------------------------------

  Name:    ______________________________________________________________

  Address: ______________________________________________________________

           ______________________________________________________________

  Country: __________________       Phone:   +____-(__)________-_________

  EMail:   ______________________________________________________________

           ______________________________________________________________

  Computer Configuration (not so necessary but nice to know):

           Amiga _________   RAM: ______ MB        HD: ______ MB

           CPU:   o 68000    o 68010    o 68020    o 68030    o 68040

                  o 68060    o other(?): _______   o FPU: ____ Mhz

           CPU has  _____ Mhz     Kickstart/WB-Version: _____________

           o I am using the Summagraphic-Driver together with a Multi-IO

             Board. (Type/Manufactor: __________________________________)

  The data provided here will be stored and processed electronically.
  It will not be given to anyone not involved in the production of the
  Summagraphic-Driver !

  I am sending my registration fee in:
    o  Dutch Guilder (20.00 DM)
    o  US Dollar (US$ 10.00)

  The way I am sending it:
    o  cash (Dutch Guilder or US $ only)
    o  EuroCheque
    o  postal money order
    o  wire bank transfer
    o  any other cheque, bank draft
       or money order. To cover any
       costs I add 10.00 DM (US$ 5.00)

                   That gives a TOTAL AMOUNT of: ___________________

  Bank-Address :     Dutch people only  Giro Account 5686868

  Don`t forget to send the Registration form to:

        Joop van de Wege
        Zoomweg 7
        6705 DM Wageningen
        The Netherlands

  I have read the copyright and warranty stuff and agree with them.


  _____________________  ____________________________________________
          (Date)                         (Signature)