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APL

Chateau Exine Adult Network
PO Box 335 Montgomeryville, Pa. 18936-9998
Network Membership Application (02-17-92)
BBS Name.............................______________________________
Your Name............................______________________________
City, ST, Country....................______________________________
Public BBS phone (NO Private #'s)....______________________________
Date of Birth........................______________________________
Modem Type/Baud for this number Only.________________ - ___________
BBS software.........................______________________________
Member of other networks (if yes who)______________________________
___________________________________________________________________
Level requested (Node, Hub, Reg).....______________________________
Net software (Rnet, Tnet, Fido etc)..______________________________
Requested hub (check nodelist).......______________________________
I agree to be responsible for assuring that only people 18 or older
will have access to these conferences. I certify that the information
on this form is correct.
_____________________________________
Signature
Return this form with proof of age to: STINGRAY BBS
(We prefer a photo copy of your P.O. BOX 335
driver's license) Montgomeryville, Pa 18936-9998