VICTORIA TELECOMMUNITY NETWORK - VTN
Personalized Account                                    APPLICATION FORM

Please accept my application for the following Personalized Account. I
agree to abide by the VTN's rules and regulations and the undernoted Terms
and Conditions. 

Personalized Account Name Requested

      First Choice: __________________   Alternate: __________________
(8 character maximum: "." and "_" are allowed. Example: jsmith 


Requestor: __________________________________ Phone: ______________

Current Free-Net ID: ________________

Signed: ____________________________________  Dated: ______________


                           Terms and Conditions

1. Personalized Accounts are assigned on a first-come basis, to currently
registered VTN patrons, that is, previously registered users.
2. Only one Personalized Account will be assigned for each application. 
3. Personalized Names which are considered objectionable by Victoria 
Telecommunity Network will be rejected.  This includes profanity and 
registered trademarks.
4. The Requestor's true name will be included and / or available to other
participants on the Internet through normal directory services and e-mail. 
That is, the Personalized Account cannot be used to mask one's true identity.

Please forward the completed application to:

                    Victoria Telecommunity Network
     220 - 4252 Commerce Circle  Victoria  British Columbia  V8Z 4M2

              Thank you for your interest and support.

Please note: Victoria Free-Net is using the operational name of 
                  VICTORIA TELECOMMUNITY NETWORK
                                                               060317 isw