


                   HDFLM Registration Form      Mail to:

                          H. D. Holland
                          2911 Chestnut Grove Dr.
                          Austell, Ga. 30001-0000

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|                                                                            |
| Name:___________________________________[ ]  HDFLM Registration $5.00US ea |
|                                                                            |
| Address:________________________________                                   |
|                                                                            |
| City:___________________ State:_________                                   |
|                                                                            |
| Zip Code:_______________ Zip+4:_________                                   |
|                                                                            |
| Make checks payable to: H. D. Holland        Total Enclosed    $_____.___  |
|                                                                            |
| What is the name of your BBS?  (Type exactly as it should appear)          |
|                           Name __________________________________________  |
|                           Phone number:       (_____)____-_________        |
|                                                                            |
| Where did you get  HDFLM                                                   |
| [] Local BBS              Name __________________________________________  |
|                           Their phone number: (_____)____-_________        |
|                                                                            |
|                           [] Other ______________________________________  |
|                                                                            |
| [] Directly from me                                                        |
|                                                                            |
| [] Friend                 Name __________________________________________  |
|                                                                            |
| [] Shareware outlet house Name __________________________________________  |
|                                                                            |
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