The Midnight Connection BBS
                  Membership + Adultmember Release Form
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    (718)-357-0429                               2400 - 14400 (USR-HST)
 Your FULL  Name:________________________________________________  
 I logged on with ID and password:_______________________________
 Desired Handle / Alias:_________________________________________ 
 Age:____              Date of Birth (MM/DD/YY)__/__/__
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 The remainder of this form is to be filled out by ALL applicants.
 _____________________________________________________________________________
 I am a ( )Male     ( )Female, and ( ) Single,Part of an Open Couple,    
        ( ) Part of a Married Couple  and I am _____ Years old
 _____________________________________________________________________________
 Please read each of the  paragraphs below careful and initial where
 indicated.
 I,the undersigned,hereby AGREE to the following:  
 I am not a member of any governmental or law enforcement agency seeking to 
 entrap the operators of this system for the purposes of civil and/or
 criminal prosecution.
  
 I believe that there is nothing illegal involved in the posting,etc. of 
 sexually explicit messages,electronic mail,files and pictures.  
 Initial here:____  
 
 I will not disseminate proprietary or classified information on the system. 
 I will neither conduct nor coordinate illegal activities via On-Line
 messages.
 Initial here:_____
     
 I understand that any violation of the above rules may result in the 
 forfeiture of membership and a revoking of access privileges.
 In addition,I am  aware that membership may be revoke at the System's 
 Operator's discretion at any time for any reason.The System Operator
 reserves the right to edit and/or remove messages.
 Initial here:____
   
 I  futher understand that some of the information accessed may be of a 
 sexually explicit nature and I freely request to this information.
   
 Initial here:____
  
 I  also waive all claims for damage,both public and private,that may occur 
 to me due to use of or access to the above menyioned information.
  
 I certify that I am over age 21 to get access to Adult Membership.  
   
 Initial here:____
 ___________________________________________________________________________
   
 All registration information is considered to be proprietary and will not be
 used for any purpose other than the maintenance of the system data base 
 files nor will it be released to anyone not connected with the operation of
 The Midnight Connection
     
 Your Signature : __________________________________________________________
    
 (Please attach a *SIGNED* copy of driver's license as proof of age)
 (Adult access WILL NOT be granted without proper proof of age!) 
 (Valid proof of age documents MUST have at least the following:
  1)Your Name  2) Your date of birth, 3) Your signature 
     
         (Remember to SIGN the copy proof of age docoment) 

-------------------------- Subscription Rates ----------------------------------------------------

Minor Membership under age 21 for one Year $ 50.00  15/1 Ratio NO Adult/access
Adult Membership over  age 21              $ 75.00  15/1 Ratio    Adult/Access 
Minor Membership for 6 Month               $ 35.00  15/1 Ratio NO Adult/Access
Adult Membership for 6 Month  incl proof   $ 50.00  15/1 Ratio    Adult/Access 
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Send signed Form and Check or Moneyorder to:
Walter Rappold
171-50 Courtney Ave
11358 Flushing NY