+------------------------------+
                        |  Midi-oke! Registration Form |
                        +------------------------------+

    To register Midi-oke! (v.2.3), please send an International Draft (payable
    to Vincenzo Palleschi) or bank-notes to:

            Vincenzo Palleschi, Via F.Pardi 17 - I-56124 Pisa (ITALY)

    Please fill in the following fields:

    Name               : _________________________________________________

    Address            : _________________________________________________

                         _________________________________________________

    Zip / City         : _____  __________________________________________

    State / Country    : _________________________________________________

    e-mail Address     : _________________________________________________


    Which is the name with which you want to register (max. 40 characters)?

                                __________________________________________


    Where did you obtain your copy of Midi-oke? (optional)

    ______________________________________________________________________


    What are your suggestions for Midi-oke? (optional)

    ______________________________________________________________________


    Thank you for your registration. You'll soon receive your registration
    number.