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Office use only Completed by ________ Date _______ Payment Recorded by ________ Donation ____ Manual, login and password, dial-up instructions, welcome letter sent (initials) _____ _____________________________________________________________________________________________
PRAIRIENET MEMBERSHIP AGREEMENT REGISTRATION FORM
I, ___________________________, affirm that I have read the Prairienet policies and agree to abide by present and future Prairienet policies. I also affirm that the membership information I have provided, including my age, residency, and membership status, is true and accurate.
Preferred Login Name: Your login will be the beginning of your e-mail address and should not be confused with your password. We try to give everyone their first choice but the login you want may already be in use by another Prairienet member. For this reason we ask for two choices. Please make sure your login is between 3 and 8 characters and please only use numbers and letters. Inappropriate login names are disallowed and will be removed or changed at the discretion of the System Administrators. Logins must be all lower case with no spaces. Preference- 2nd choice address: ________________________________________________________________________________ Street _______________________ _________ ___________________ City State Zip My phone number is: (_______)_______________ My date of birth is: ____/_____/______ My operating system is (check one) ___ Windows XP ___ Windows 95, 98 or 2000 ___ Mac OS X ___Mac pre-OS X I am applying for one of the following (please check one): ___ Limited Membership (no dial up access) $35 per year, for people who already use another Internet Service Provider. It provides an e-mail account, access to newsgroups and storage space. You will have 20 MB of space for e-mail and 10MB for webpages. ___ Individual Membership $90 per year, allows 10 hours of internet time per day. You will have 20MB of space for e-mail and 10MB for webpages. ___ Household Membership $170 per year, this account allows up to 5 school age or older members of a household to have their own accounts with their own internet time, logins and passwords. Each member needs to fill out and sign their own application. This account offers the option of being paid yearly or every 6 months. ___ NetNeighbors Free account (must fill out Netneighbor application form and provide verification that you meet our low income guidelines) offers same advantages as an individual account. Only one Netneighbor account per household. ___ Student Account $70 (must show student ID or send in copy of student ID) same features as an individual account. ___ Senior Account $70 (60 years or older - must show or send proof of age) same features as an individual account. ___Other :_____________________________________________ Please enclose or show one of the following: Photocopies of the following proof of age/residency (check one): ___ Driver's license or State ID ___ Passport ___ other Payment options___A payment for $_____ plus a $______ donation to help support the NetNeighbors Program, Public Access Sites, and the East St. Louis Project. (checks should be made out to Prairienet) ___ Please charge me $_____for service plus $_____ donation = total $_______ Charged to my (circle one) Visa/ Mastercard/ American Express My credit card number is:_________________________________________ Expiration date:___/____ Signed:__________________________________________ Date:_______________
The Prairienet Acceptable Use Policy To ensure a beneficial and quality experience to all Prairienet members, Prairienet members are required to adhere to the following criteria for Acceptable Use in addition to all applicable State and Federal laws. Prairienet members are expected to use good judgment in all their activities, and help provide a positive image of Prairienet to other members and to participants in networked communication forums. 1. Prairienet members are responsible for all activity carried out through their account. NEVER share your password with anyone. 2. Anonymous accounts are prohibited on Prairienet. All accounts must carry the real name of the user as verified with proper ID. 3. Prairienet members are requested to act with respect for the values and individuality of other members and the rest of the network community. Behavior which expresses prejudice, harassment, or disdain for personal, intellectual, racial, sexual, or other reasons is bad network citizenship. Remember that many types of harassment are against the law. Prairienet will cooperate fully with the prosecution of any member accused of harassment. 4. It is not acceptable to use Prairienet in ways that interfere with or disrupt users, services or equipment on Prairienet or any connected system or network. Such interference or disruption includes, but is not limited to: distribution of unsolicited advertising; propagation of computer worms or viruses; and using the network to make unauthorized entry to other computational, information, or communications devices or resources. 5. Unsolicited communication with Prairienet members or Internet users is generally discouraged. This includes, but is not limited to, uninvited "talk" connections and email. Good judgement should be exercised when sending a message to someone you do not know. Chain mail, or anything resembling chain mail, is specifically forbidden in all circumstances. 6. Prairienet members must observe all applicable copyright laws. Copyrighted materials may not be used on the Web without permission of the copyright owners. 7. Prairienet tries to maintain a "family-friendly" atmosphere. Prairienet members are urged to refrain from obscenity in any public area. Prairienet reserves the right to create public areas which are specifically for the use of youth members, the contents of which will be moderated. 8. Illegal activities are not permitted on Prairienet or using Prairienet resources. 9. Limitations for commercial uses of Prairienet exist, and are detailed in the document "Commercial Uses of Prairienet." I have read and agree to abide by the above policies______________________________________________________ __________________________ Signature Date MAIL TO: Prairienet, P.O. Box 17371, Urbana, IL 61803 Once we receive your paperwork we will create the account and send you the information to set it up on your system through postal mail. Payment ChartWe want all Prairienet accounts to expire on December 31st of each year. Please refer to the chart below to determine what your payment will be. You also have the option of paying for more than one year by adding an addition of one year’s cost to your payment. Renewal notices are sent through e-mail beginning a month before your account is due to expire. If you apply after the 15th of the month current month pay the rate listed for the next month.
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Updated: 10/18/06