Personal Signup

Enter The following REQUIRED information:

First name
Last name
Middle name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Employer
Title
Work Phone
Home Phone
FAX
E-mail
URL	if you have a Web Site

 

Please fill out these personal attributes:

Date of birth
Sex	Male Female
Height
Weight
Hair color	Blonde Brown Black Red Gray White Other
Eye color	Blue Brown Black Green Gray Hazel Violet Other

Describe yourself (awards, honors, habits, education, employment, history, etc):

List your interests & hobbies:

 

What type of computer do you use?

None Pentium Pro Pentium 386/486 (IBM/Compaq, etc.) 586/686 (IBM/Compaq, etc.) PowerPC DEC Alpha PS/2 Sun Sparc Other

What operating system do you use?

None Windows 95 Windows 3.x Windows NT Macintosh (System 7.x) NeXT Unix (any type) DOS Other

What type of Internet connection do you have?

None America Online CompuServe Dial-Up Modem (ISP) Dial-Up ISDN (ISP) Dedicated Modem (ISP) Dedicated ISDN (ISP) Dedicated Network GEnie Prodigy Other

Do you have e-mail?

Yes No

Enter type of Web Page you want:

Personal Page Anonymous Personal Page Custom Site Already Have One Don't Know

Choose a Domain Name (pick "your_name" for "www.CleveNet.com/your_name")
Note: Short, but descriptive names are best. Subject to availability

First Choice: 
Second Choice:
Third Choice: 

Estimate number of Web Pages you might need:

 

Do you want to be listed in our "personals" section?

Yes No

If you said "yes" to being listed in the "personals" section, select any of the following personals options that apply:

None
Women Seeking Men
Men Seeking Women
Seeking Friendship
Seeking Pen Pals
Special Situation

 

For a "personals" link, describe the desired traits of the person(s) you are seeking:

Do you want your address listed in your Web Page?

Yes No

If you said "no" above, Do you want a P. O. Box in your Web?

Yes No

Enter your P.O. Box address, if any:

Do you want your Home Phone Listed?

Yes No

Do you want your Work Phone listed?

Yes No

Do you want your e-mail listed?

Yes No

Do you want an anonymous page (we CANNOT guarantee that you cannot be found!)?

Yes No

If "yes" above, enter your anonymous Web Name in the space provided below.

Would you like your photograph in your Web?

Yes No

Do you have any additional graphics for your Web?

Yes No

Enter any favorite Web Site links:

 

Do you want your page set up immediately?

Yes No

 

How would you rate this Web Site?

awful poor average good excellent

Please leave any comments about this Web Site: