 
          LASER BLOCKS REGISTRATION
                                            

          Name             ________________________

          Company          ________________________

          Address          ________________________

          City/State       ________________________

          Zip/Postal Code  ________________________

          Country          ________________________

          Phone            ________________________

          EMAIL ADDRESS    ________________________
                         If you include your eMail address, we can
                         send you the registration by email.

     I AM ORDERING:
        
     (  ) LASER BLOCKS              ($10 US)
     (  ) MIXLINE                   ($10 US)

     -- ADD SHIPPING & HANDLING $5 US --                            

     I WILL ALSO RECEIVE THE BONUS GAMES
     VOLUTARE AND FRUSTRATION (DESCRIBED IN BONUS.TXT)         
        
     Amount Enclosed: $ _________ US

     Make your check or money order payable to Bela von Hoffmann.

     Mail payment and registration form to:    Bela von Hoffmann
                                               Haga Nygata 21b
                                               413 01 Gothenburg
                                               Sweden
     Payment Method:

      ___ Check   ___ International Money Order  ___ Cash 
      
     
        
     PRINT AND USE THIS FORM FOR MAIL ORDERS.

     For online orders (via credit card or postgiro): 
     http://www.nicetime.nu
         