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                       MED CX V4.02 for Win32 registration form
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        Please fill in the needed information and send this form to

        by mail:     Matthias Pfersdorff Software Engineering
                     Theodor-Krner-Str. 10
                     D-76275 Ettlingen
                     Germany

        by E-Mail:  sales@med-editor.com

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        Please fill in your name and address:

        __________________________________________________

        __________________________________________________

        __________________________________________________

        __________________________________________________


        E-Mail : ___________________________


        I have paid the registration fee (US$30 / EUR 25) by

        ( ) Bank Transfer to

            Matthias Pfersdorff
            Bank: ING Diba
            IBAN: DE40500105175404611816
            BIC: INGDDEFFXXX

            (when transferring from outside Germany, add
             EUR 3 / US$ 3)


        ( ) Cash



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       comments and suggestions:

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