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This form below must be returned with a copy of your Florida ID or drivers license. (WITHOUT the ID/DL copy you will NOT gain access) Fill this out honestly and completely. ALL INFORMATION SUPPLIED IS TREATED AS TOTALLY CONFIDENTIAL AND IS NOT KEPT IN ANY COMPUTER FILE. NO ONE BUT YOU AND THE USG SYSOP WILL KNOW WHAT THIS APPLICATION CONTAINS. WE WILL AFTER ESTABLISHING YOUR USER RECORD CALL YOU VOICE TO (1) VERIFY YOUR APPLICATION AND (2) TO ADVISE YOU OF THE LOG IN ID TO USE. FALSE INFORMATION SUPPLIED WILL RESULT IN TERMINATING YOUR ACCESS. (If there are any problems call first and advise) DATE:________________________ TRUE NAME:____________________________ MAILING ADDRESS:_______________________________________________________ CITY, STATE, ZIP: ___________________________________ __ ___________ VOICE TELEPHONE:____________________ BEST TIME TO CALL: ______________ NAME USED AS LOG-IN WHEN CALLING PR:___________________________________ (If log-in is NOT real name) CURRENT PASSWORD: ____________________ SEX: __ AGE GROUP (Mark A or B whichever applies Group 'A' Under 35. 'B' 35 and over). A _______ B _________ ENTER A ONE WORD CODE NAME FOR USG (NOT TO EXCEED 12 CHARACTERS: CODE NAME: ____________________________ (Your ID Code will be entered by us. Use it as your 'Last name') PASSWORD FOR USG: ___________________ (Limit 8 characters) SEXUAL PREFERENCE: STRAIGHT: __ GAY: __ BI-SEXUAL __ LESBIAN: __ (Check one of the above. See below) MARRIED: __ NEVER MARRIED: __ DIVORCED: __ WIDOWED: __ LIVE W/SOMEONE: ___ LIVE WITH RELATIVES: __ LIVE ALONE: __ CHILDREN? (NUMBER + AGE(S)):_________________________________ HEIGHT: _____ WEIGHT: _______ HAIR: ______ EYES: ______ SUN SIGN: _____________ MONTH/DAY OF BIRTH: _______________ (Aries/Gemini/ect) (Like Jan 5 list as 01/05) PURPOSE FOR JOINING: (Just for fun, looking for companion, marriage just a friend, ect) _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ INTERESTS: (Books, plays, sports,music, ect) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ TELL US ABOUT YOURSELF: _______________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ TELL US WHAT YOU TYPE OF PERSON YOU ARE LOOKING FOR: __________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Information will be taken from this for your bio... BE SURE to look over it on your FIRST CALL.. if you wish anything changed or deleted or added ADVISE AT ONCE!! Signature:_____________________________________________________________ If you downloaded this form and HAVE NOT READ BULLETIN ON USG ... READ IT BEFORE APPLYING!!!


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