Seattle Community Network (SCN) User Registration Form

All registered users of SCN MUST agree to the following Code of Etiquette
while using the system: 

1)  I will not knowingly engage in illegal distribution practices when 
       posting information. Some examples of illegal distribution are:   
       posting large portions of copyrighted material;  posting libelous 
       material;  posting material that knowingly aids in a crime;  posting 
       credit card number;  posting passwords.
2)  I will not attempt to gain unauthorized access to SCN nor use SCN to
       gain unauthorized access to other systems.
3)  I have read the the SCN disclaimer.
4)  I have read and understand the SCN policy statement and agree to 
       abide by it as the governing policy of the SCN.
5)  I will read the description of the forum to which I am posting and 
       post only material relevant to its purpose and theme.
6)  I will not use the SCN to harass individuals or organizations.
7)  I understand that all public material on SCN may be redistributed, 
       subject to copyright laws.
8)  Private e-mail may not be redistributed without permission from the 
       originator of the message.

(Please PRINT legibly - except for the signature, of course)

User's Name:  __________________________________Phone (optional):___________

Address:________________________________________

Address:________________________________________

City:_____________________________ State/Prov:_______________

Zip/Postal Code: _________________ Country:__________________
 	
Organization or Affiliation:_________________________________
			
User Signature (required!) __________________________________

Date:_______________

Signature of parent/guardian for minors______________________

Date:_______________

In order to be able to verify your identity over the phone or by email (in
case of password problems, etc.), we need a verification code.  This will
be in the form of a question that you want us to ask you, and the answer. 
For example, you might have the question be: "What is the name of my
dog?", and supply the answer.  Then if we need to verify your identity, we
will ask you the question, and you supply us the answer.  If we don't have
this verification information, then we will need to send new passwords or
other information to you in the mail. 

________________________________________________________________
Verification Question

________________________________________________________________
Verification Answer

    If you do not want your real name (as listed above) to appear 
    with your e-mail or contributions to public forums, 
    check here: _____________   
    (If you make this selection, only your user-id will appear in 
    the header information.)

For a free user-ID, fill out the section above.  SCN will automatically
assign you a unique identifier (for example, bb001), which you use when
you login to the SCN system and to receive electronic messages (e-mail). 

If you prefer, we can assign you a customized user identification
(user-id). For this, we request a voluntary one-time donation of $15.00. 
To get your custom ID, fill out the section below.  You must include three
choices, in order of your preference (some user IDs may be already in
use).  They will be lower case letters and digits only, up to eight (8)
characters each. 

1. _____________________________ 

2. _____________________________    

3. _____________________________


In addition, the SCN project always needs additional funds.  Please consider
making a donation to cover costs, especially much-needed hardware upgrades!

Donations will be published unless you check here _______ to make this 
donation anonymous.

_______  $15.00 (custom user-id)

_______  $25.00 (Basic)

_______  $50.00 (Family)	

_______  $100.00 (Patron)

_______  $500.00 (Corporate)

_______  (other, please specify amount)

_______  Total amount enclosed  (make checks payable to CPSR/SCN)

Thank you for taking the time to become a registered user of the Seattle
Community Network.  We will send you your identification, password and
login instructions by US Mail (this may take up to three weeks).  Send
completed, SIGNED registration form and optional donation check (made out
to CPSR/SCN) to: 

Seattle Community Network Assn. (SCNA)
Post Office Box 15387
Seattle, WA 98115

______________                 
SCN USE ONLY                  
Data Entry:			Received Date:                    
Account Generated:              Donation Amount:
Letter Sent:                    Check #/M.O./cash:
				Initials: