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                  MedTxt version 1.0 Order Form 
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Send registration fee to:
Dudley Darr
6352 Clinton Highway
Knoxville, Tn 37912
USA

Please send me by check or money order:

_____ MedTxt Version 1.0 ........................@ $25.00 ea $ _____

Shipping and Handling....US/Canada/Mexico: $5; Overseas: $10 $ _____

                  TOTAL (U.S. Funds drawn on	U.S. Bank)   $ _____
                     
Name: ______________________________________________________

Address: ___________________________________________________

       : ___________________________________________________
	   
       : ___________________________________________________
	   
       : ___________________________________________________
	   
Phone: ___________________________

I need _____ 5 1/4" disks ______ 3 1/2" disks.

I received this program from: ______________________________________

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