Your name: | | Your name |
Your email address: | | Your email address |
Please ensure that you enter a valid email address above, or we won't be able to reply to your message. |
requested name: | | [domain name requested] |
to represent: | | [the project, initiative or organisation for which the domain is being registered] |
domain owner: | | [the name of the proposed domain owner organisation] |
descr: | | [Provide information as required by section 1.9.3.1 of the eligibility guidelines:] |
descr: | | [Status of the organisation] |
descr: | | [Role and objective of the organisation] |
descr: | | [The status of staff within the organisation] |
descr: | | [The source of funding for the organisation] |
descr: | | [To whom the organisation is accountable] |
descr: | | [Purpose of domain name] |
|
admin-c: | | [Name of the admin contact] |
address: | | [full postal address of contact] |
phone: | | [telephone number of contact] |
fax-no: | | [fax number of contact] |
e-mail: | | [e-mail address of contact] |
|
tech-c: | | [Name of the technical contact] |
address: | | [full postal address of contact] |
phone: | | [telephone number of contact] |
fax-no: | | [fax number of contact] |
e-mail: | | [e-mail address of contact] |
|
reg-c: | | [Name and position within the domain owner organisation of the registrant contact] |
address: | | [full postal address of contact] |
phone: | | [telephone number of contact] |
fax-no: | | [fax number of contact] |
e-mail: | | [e-mail address of contact] |