NAME:

SITE NAME:

SITE URL:

VOTING EMAIL ADDRESS:

CONTACT EMAIL ADDRESS:

DATE OF BIRTH (YYYY/MM/DD):

REFERRED BY A MEMBER? Please tell us who:

GENDER - FEMALE or MALE?:

FEMALE

MALE

PLEASE SELECT FROM ONE OF THE CHOICES BELOW FOR TEAM PREFERENCE:

 NO PREFERENCE

NORTHERN LIGHTS

SOUTHERN CROSS

After your application has been accepted, your selected Team's Leader will contact you with a Welcome packet and you will, at that time, be requested to supply the names and email addresses of family and/or friends using your IP address who will also be voting for your site. Remember, you are permitted to have only five (5) additional addresses at your IP address.