--- please PRINT your answers ---
I am paying (select either 3 months or a year):
_______ $39.95 USD membership for three months
_______ $69.99 USD membership for a year
What is your first and last name?
What is your email address?
What username would you like? (This could be the first part of
your email address, for example.)
What country do you live in? _________________________________________
Please select one of the following as your security
question (in case you forget your password):
1 What is your mother's maiden name?
2 What is your favorite pet's name?
3 What is your favorite movie?
4 What city was your father born in?
5 What city was your mother born in?
6 What is your father's middle name?
7 What is your mother's middle name?
I want question #_______ as my security question.
What is your answer to the question you chose? (Hint: keep it
simple so you can remember it, but not obvious so someone
can guess it.)