Online Policy Group Services: Create Domain

















	Terms of Service, Other Policies, and Copyright ©2000-2003 Online Policy Group, Inc.

Create Domain

Please fill out this form to request registration of a new web domain.
Need help filling out this form? Click here.

*First Name:
Middle Name:
*Family Name:
*Email:
*Phone (primary):
Phone (backup):
*Street Address:
*City/Town:
*State/Province:
*Postal/Zip Code:
*Country:

*Affiliation:
Organizational Use
Individual Use

Organization name (skip if for "Individual Use"):

*Description of organizational or individual activities (brief):

*Annual Budget (US$):

*Usage:
I agree that I will use this service only for nonprofit activities.

*Domain name requested:
*Domain type:	.org .net
*Domain service username requested:
*Domain service password requested:
*Confirm password:

*I certify that I am 13 years of age or older (required by COPPA law in the United States).

I agree to a public advertisement of the email list, website, domain, or other services I've requested on the Online Policy Group (or its projects) websites, brochures, and grant proposals.
Note: You will be added to an administrator email list to keep you informed of service changes and other announcements.

Click here to submit your report (click only once!), then make sure to complete the request process by reviewing and submitting any forms following this one.

Although OPG designed this form to run in secure mode with the designation https:, you may have trouble running the form in some browsers or network configurations, in which case you may decide to run it in non-secure mode by using the designation http: in the web address.

The Online Policy Group Privacy Policy covers the use of all information you provide on this form.

Need help filling out this form? Click here.

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