Please complete for membership:

                   PLATINUMNET/SUPRTNET  APPLICATION  FORM

ARE YOU APPLYING FOR:    [ ] HUB STATUS           [ ] NODE STATUS

SYSOP'S NAME:_________________________________________________________

MAILING ADDRESS:______________________________________________________

CITY:____________________________  STATE:___________  ZIP:____________

VOICE TELEPHONE:______________________________________________________

IS THIS PHONE:  [ ] HOME       [ ]  BUSINESS
   (where ever possible please provide a home phone number)
IF PLATINUM EXPRESS NEEDS TO CONTACT YOU VIA A

VOICE CALL, WHAT IS BEST TIME TO CALL?________________________________

BBS NAME:_____________________________________________________________

BBS TELEPHONE:________________________________________________________

NUMBER OF NODES:___________  MAXIMUM BAUD RATE:_______________________

NUMBER OF YEARS BBS IN OPERATION:_____________________________________

BBS SPECIALITY (IF ANY):______________________________________________

BBS SOFTWARE:_________________________________________________________

NODE ID DESIRED_______________________________________________________

HUB INTERESTED IN RELAYING WITH_______________________________________

SERIAL NUMBER OF BBS SOFTWARE_________________________________________

WHERE DID YOU HEAR ABOUT US?__________________________________________

HAVE YOU READ A COPY OF THE NETWORK BY-LAWS?       [ ] YES      [ ] NO

DO YOU AGREE TO THE ACCEPT THE NETWORK'S BY-LAWS?  [ ] YES      [ ] NO


SIGNATURE:________________________________________  DATE:_____________

Please complete and return this form to:

                            Glenn Jarvis
                            411 Allen Court
                            Richmond Hill,Ontario,Canada
                            L4C 1G4
Voice = 416-770-6917 10am - 6pm EST  (Computer Print)
Membership Fee = $.00