Please fill in all the blanks below and submit via the button at the bottom of this page. Thanks for joining us!
Last Name:
First Name:
E-Mail Address:
Name of Company or Organizaton:
Address:
City:
Province or U.S. State:
Postal Code:
Enter the 2-letter ISO Code for your nation (ie: US, UK, AU) or the nation name:
Enter your complete telephone number with country code and any area codes:
Enter Your FAX number:
Enter a list of all TLDs that you hold, separated by commas (See definition of "TLD HOLDER" above). TLD's HELD:
Please indicate the method by which you claimed any one or more of your TLDs.
For any one or more of your TLD's, indicate which root server networks your TLDs are listed (200 characters or less):
For any one of your TLDs - specify the host name of a name server which carries the Start of Authority record for your TLD:
For any one of your TLDs - specify the host name of a second name server which carries the Start of Authority record for your TLD:
If you have a registration or informational website for your customers, please put in the URL here:
http://
If none of your TLDs are operational yet, please indicate the first date on which you expect any one of your TLDs to be operational.
If there are any other comments or considerations that you would like to be considered by the membership committee when evaluating your application, please state them here (200 characters or less):
