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<title>Registration for full access to GB7BAA</title>
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<td valign="center" align="left"><font face = "verdana,Arial,sans-serif"font color="#606060" size=+1>GB7BAA DX
Cluster<br>Registration</font></td>
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<h3><font color="#606060">Apply for full access (registration)</font></h3>
<p>To request registration as a full-access user of GB7BAA please fill in the form and press
the 'submit' button. Items marked with a star (<font color="red">*</font>) must be provided in case we
need to contact you to confirm your details.</p>
<p>You should receive a copy of your registration request by email and a few days later
confirmation that your registration has been accepted and your full-access status enabled.<p>
<h4><font color="#606060">Registration details</font></h4>
<form method="post" action="/cgi-bin/registration.pl">
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<td><font size=2>Callsign</font></td>
<td> </td>
<td><font color="red">*</font></td>
<td> </td>
<td><input type="text" name="callsign" size=8 maxlength=8></td>
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<td><font size=2>Name</font></td>
<td> </td>
<td><font color="red">*</font></td>
<td> </td>
<td><input type="text" name="name" size=40 maxlength=40></td>
</tr>
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<td><font size=2>Password</font></td>
<td> </td>
<td><font color="red">*</font></td>
<td> </td>
<td><input type="password" name="password1" size=12 maxlength=32></td>
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<td><font size=2>Password (confirm)</font></td>
<td> </td>
<td><font color="red">*</font></td>
<td> </td>
<td><input type="password" name="password2" size=12 maxlength=32></td>
</tr>
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<td><font size=2>Email address</font></td>
<td> </td>
<td><font color="red">*</font></td>
<td> </td>
<td><input type="text" name="email" size=40 maxlength=80></td>
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<td><font size=2>Address 1</font></td>
<td> </td>
<td> </td>
<td> </td>
<td><input type="text" name="addr1" size=40 maxlength=60></td>
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<td><font size=2>Address 2</font></td>
<td> </td>
<td> </td>
<td> </td>
<td><input type="text" name="addr2" size=40 maxlength=60></td>
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<td><font size=2>Address 3</font></td>
<td> </td>
<td> </td>
<td> </td>
<td><input type="text" name="addr3" size=40 maxlength=60></td>
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<td><font size=2>Address 4</font></td>
<td> </td>
<td> </td>
<td> </td>
<td><input type="text" name="addr4" size=40 maxlength=60></td>
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<td><font size=2>Postal Code</font></td>
<td> </td>
<td> </td>
<td> </td>
<td><input type="text" name="postcode" size=12 maxlength=20></td>
</tr>
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<td><font size=2>Country</font></td>
<td> </td>
<td> </td>
<td> </td>
<td><input type="text" name="country" size=40 maxlength=40></td>
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<td><font size=2>Home Phone</font></td>
<td> </td>
<td><font color="red">*</font></td>
<td> </td>
<td><input type="text" name="hometel" size=20 maxlength=32></td>
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<td><font size=2>Mobile Phone</font></td>
<td> </td>
<td> </td>
<td> </td>
<td><input type="text" name="mobiletel" size=20 maxlength=32></td>
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<p>I confirm that I have read the <a href="aup.html">Acceptable Use Policy</a> and agree to its terms and conditions.</p>
<p><input type="submit" value="Submit Registration"> <input type="reset" value="Reset Form"></p>
</form>
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<h4><font color="#606060">Privacy Statement</font></h4>
<p>The information that you supply in order to register will only be used to validate you as a user of the
DX cluster system and will not to disclosed to any third-paty for marketing, sales or any other activity (unless required by law).</p>
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Copyright © 2001 by Mike Tubby G8TIC. All Rights Reserved.<br>
<font color="#000000">Last updated 25<sup>th</sup> May 2005
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