|New Account Creation - COPPA Request Form|
|Instructions for Parent or Guardian|
According to the Childrens Online Privacy Protection Act of 1998 (COPPA) you must provide in written form this membership request form. The purpose of this request is to gain access as a 'Registered Member' of the dotNetBB forums found online at http://forum.makemusic.com/.
Upon completion please send the completed form by mail to :
Attn: Customer Support
7007 Winchester Circle, Suite 140
Boulder, CO 80301
or fax to 720-465-6419
|Real Name : |
Please enter your real name (Administrative purposes only).
|User Name : |
Please enter a user name for your profile. This cannot be changed once selected.
|Password : |
Please choose a password you will remember (cannot be blank!).
|E-Mail Address : |
A valid e-mail address is required.
|Parental or Guardian Approval|
|Full Name of Parent or Guardian : |
|Signature : |
|Relationship to Child : |
|Contact Telephone : |
|E-Mail address of Parent or Guardian : |
|Today's Date : |
|Please contact Forum Administrator at [email protected] with any questions regarding this form.|
|Terms of Service|
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