Web Server Account Form

To receive an account, please provide the following information, sign the 
agreement, and mail it to:

        RockNet c/o Bob Ekman
        524 Carr Ave
        Rockville, MD 20850


Name: ________________________________________________________________________

Address: _____________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Phone Number: __________________________Fax Number: __________________________

E-mail Address: ______________________________________________________________

Organization Desiring Web Page Hosting:

______________________________________________________________________________

______________________________________________________________________________

Purpose for Requesting an Account:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

As a representative of the above organization, I request an account on the 
RockNet web server.  I will use this account to maintain web pages in accordance
with the RockNet policies, as they are now or amended in the future.

Signature: _____________________________________ Date: _______________________

This account remains the property of RockNet and will be granted to you solely
for your stated purpose.  It may be withdrawn at the sole discretion of the
RockNet Board of Directors.  You will be notified of any significant changes to
the RockNet mission, policies, or this account through e-mail.