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