IP REGISTRY FORM If you fill out by hand, please write legibly and clearly. Then scan page, turn document into jpg of 300dpi or higher, and return to J. Marcer. Approval of IP address will be emailed to you at primary email addres.

Member Name: IP Location: Country: Primary email address: Secondary email address:

IP ADDRESS ____ ____ ____ ____ ____ Date entered:

All IP addresses below are changes applied for and granted by the Web Administrator, J. Marcer and approved by Webmaster Pierre Haobsh.

IP ADDRESS ____ ____ ____ ____ ____ Date entered: Approved: IP ADDRESS ____ ____ ____ ____ ____ Date entered: Approved: IP ADDRESS ____ ____ ____ ____ ____ Date entered: Approved: IP ADDRESS ____ ____ ____ ____ ____ Date entered: Approved: IP ADDRESS ____ ____ ____ ____ ____ Date entered: Approved: