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   |  Las Vegas  |          Application For Access to Adult Material
   |  Playground |
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   Please complete the following information truthfully. You must be 21
   years of age to register. All answers will be held in a confidential
   manner. The answers you supply will not be used for any purpose other
   than to verify suitability for access.

    Full Name:__________________________________________________

      Address:__________________________________________________

         City:________________________ State: _____ Zip: _______________

   Home Phone:_______________________ Birthdate: ________________

  Please answer the following questions. Please initial each where indicated
  in your own hand. If any answers are blank, or any of the below statements
  are not initialed, this registration form will NOT be processed. LVPG
  is considered to be the same as Las Vegas Playground.

  1. Under penalty of perjury of law, I hereby swear that I am at least 21
     years of age or older. Initials:____   Please print your AGE: ____

  2. I understand that the adult areas of LVPG might contain
     nudity and sexually explicit materials. Initials:____

  3. Of my own free will, and of my own choice, I choose and request to view
     the sexually explicit materials and/or message bases. Initials:____

  4. I understand that I am the only person allowed to access LVPG
     on this registration, and I will not transfer it to, or let anyone else
     access LVPG via this registration. I also will make NO claims
     should someone in my family or otherwise use my password to access
     LVPG. Initials:____

  5. I will not display, nor make available for display, the sexually  
     explicit materials received from LVPG to anyone under the age of 21.
     Initials:____

  6. I have investigated the Federal, State & Community obscenity/pornography
     laws and will not access any information on LVPG which would
     violate those laws. Initials:____

  7. I have enclosed a photocopy of my legal identification which shows my
     birthdate. (State Driver's License, Military I.D. etc.) Initials:____


     Signature:__________________________________ Date:___________________


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    Please FAX or mail this form with the copy of your legal I.D. showing your
    birthdate. Your application will be reviewed and if accepted, you will be
    upgraded within 24 hours after reciept of form.

                                       Las Vegas PlayGround
                                       PO Box 85178
                                       Las Vegas, NV 89185-0178
                                       Voice (702) 388-1776
                                       FAX   (702) 388-1761
                                       BBS   (702) 386-7979

    ** Return this form and copy of your valid ID today for a FREE two week
       trial membership.