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	Full Name *   Age * E-Mail Address * Website URL   Site Title     Would you prefer CGI access?   Yes No Do you know how to use FTP?   Yes, no problem Just about Not really Select... Any other requirements?   Which category best suits your site? If you have a personal site centered around your blog, please choose blog. Other is for cliques, poetry sites etc.   Personal Site Weblog Collective Journal Other (misc.) Select... How can potentional hosts contact you? * E-mail Sign book AIM ICQ MSN YIM GTalk Via my site Select...   Short site Description     Have you been hosted before? If so, what is the reason for leaving your current/old host?     How many years have you been web designing?     ICQ Address     AIM Address     MSN Address     YIM Address     GTalk Address     Additional Notes     Security Code: *

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