MEMBERSHIP REGISTRATION -- THE GAY CAFE -- http://www.gaycafe.com/
Please write legibly in ink, or type your form. Submit the completed
form either by fax or postal mail along with your payment. You may
use e-mail to submit the form if paying by credit card or requesting
a complimentary (free) or reduced cost (send donation) account.
1. What is your Internet E-mail address?
___________________________ @ ____________________ . __________
2. What is your Full Name?
_______________________________________________________________
3. When is your birthday (MM/DD/YY)? ________ / _______ / ________
4. What is your City, State (or Province), Country, and Zip code?
_______________________________________________________________
5. Choose a Cafe User ID: (nickname)
(4 to 12 characters - all lowercase) ________________________
6. Choose a Cafe Password:
(4 to 8 characters - CaSe SeNsItIvE) ________________________
7. Choose a subscription level:
_____ US 14.95 - Curiosity - One Month
_____ US 27.95 - Wanderer - Three Months
_____ US 49.95 - ValueMan - Six Months
_____ US 89.95 - Sugar Daddy - One Year
8. PAYMENT: < Cash > < Check > < Money Order >
--- Write Checks to: INTERNATIONAL CAFE, INC. ---
Check or Money Order Serial Number: _________________
Your Signature: _____________________________________
9. How did you find the site? Are there any questions that you have?
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
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Please limit the registration form to a single sheet of paper. Your account
will be created on the same day that your form and payment are received. An
e-mail verification will be sent, so make sure to give the correct address!
If applying for a free or reduced cost account, please use section number 9
to make your request, and email it to nathan@npj.com along with the rest of
this form. Be sure to select which account level you're inte
rested in.
Thank you! I look forward to having you as my guest to The Cafe.
Nathan Johansen, Owner
nathan@npj.com
Postal Mail: International Cafe, Inc.
P. O. Box 746044
Arvada, Colorado 80006-6044
United States of America
Europe Mail: The Gay Cafe Europe
Sprendlinger Landstr. 120
D-63069 Offenbach
GERMANY
FAX: 1-888-860-6062 Toll-Free in USA
1-281-582-5770 Direct Dial USA
+49 (069) 845 991 Direct Dial GERMANY
You may also register on-line. Visit this link for more details:
http://www.gaycafe.com/access.html
15 September 98 - Basic Form
18 April 2001 - Free/Reduced Cost Accounts
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