|USER SUBMISSION FORM
Username: Your desired username to log in with. Up to 20 characters. Do not use special characters. Only A-Z, a-z, 0-9 and ! should be used.
Password: Your desired password to log in with. Up to 20 characters. Do not use special characters. Only A-Z, a-z, 0-9 and ! should be used.
Real Name: Your real name.
Address: Your address. [ Optional ]
City: Your city. [ Optional ]
State/Province: Your state or province. [ Optional ]
Zip/Postal Code: Your zip or postal code. [ Optional ]
Country: Your country. [ Optional ]
Email Address: Your email address. [ Required ]
AOL IM Screen Name: Your AOL Instant Messenger or AOL screen name. [ Optional ]
ICQ Number: Your ICQ number, if applicable. [ Optional ]
Yahoo IM Screen Name: Your Yahoo Instant Messenger screen name. [ Optional ]
MSN ID: Your MSN messenger ID. [ Optional ]
Subscription Period: Select the period you are applying for.