Chat Resort Membership Form

Please provide your current age
Please provide your current home address
Provide a login name of your choosing. Please keep in mind this must be lowercase and one word. This will be used as your webspace login as well.
Your Chat Name you would like reserved. You may include html coding so that everything is saved properly.
Your password must be at least 5 characters long or longer.
Please be sure of which membership you wish to purchase before finalizing the rest of the information.
If you are purchasing the $30.00 membership plan please provide the room name.
If you are purchasing the $30.00 membership plan please provide a room password for your private room.
If you feel there is any other information that is required lease provide that here.

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