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PERSONAL TIME ARRANGER VERSION 1.1 REGISTRATION FORM

All lines of this form must be completed in full in order to 
process your registration. Please make checks or money orders
payable to "D.P. Nowotnik" and send to:

                David P. Nowotnik
                1-H Raylon Drive,
                Baltimore, MD 21236
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PERSONAL TIME ARRANGER REGISTRATION FEE:

Check One 
Single User Registration [  ]

    Quantity:  ______ copies at $20.00 (U.S.) per copy _________

      Group Registration [  ]

    Number of users:  ______ : Total registration fee  _________
        
    MD State residents add 5% sales tax                _________

    TOTAL                                              _________  
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PURCHASHER'S NAME AND ADDRESS: 




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For a Group Registration, specify an authorized Representative
or Contact, with Title: 

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I obtained a copy of the Shareware version of PTA from (mark one):

  [  ] An online service/BBS (Specify: __________________________)
  [  ] The Internet     (Specify site: __________________________)
  [  ] A friend
  [  ] Other (Specify: __________________________________________)

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The purchaser agrees to abide by all of the terms of the license
agreement, as given in PTA.doc 
 
    Purchaser's Printed Name: ___________________________________

                   Signature: ___________________________________

                        Date: ______________
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