This form below must be returned with a copy of your Florida ID
or drivers license. 

   (WITHOUT the ID/DL copy you will NOT gain access)

Fill this out honestly and completely. 

ALL INFORMATION SUPPLIED IS TREATED AS TOTALLY CONFIDENTIAL AND IS
NOT KEPT IN ANY COMPUTER FILE. NO ONE BUT YOU AND  THE USG SYSOP WILL
KNOW WHAT THIS APPLICATION CONTAINS.

WE WILL AFTER ESTABLISHING YOUR USER RECORD CALL YOU VOICE TO (1) VERIFY
YOUR APPLICATION AND (2) TO ADVISE YOU OF THE LOG IN ID TO USE.

FALSE INFORMATION SUPPLIED WILL RESULT IN TERMINATING YOUR ACCESS.

        (If there are any problems call first and advise)
    

DATE:________________________    TRUE NAME:____________________________

MAILING ADDRESS:_______________________________________________________

CITY, STATE, ZIP: ___________________________________  __   ___________

VOICE TELEPHONE:____________________  BEST TIME TO CALL: ______________

NAME USED AS LOG-IN WHEN CALLING PR:___________________________________
                      (If log-in is NOT real name)

CURRENT PASSWORD: ____________________   SEX: __  

 AGE GROUP (Mark A or B whichever applies Group 'A' Under 35. 'B' 
            35 and over).

      A _______       B _________  

 ENTER A ONE WORD CODE NAME FOR USG (NOT TO EXCEED 12 CHARACTERS:

     CODE NAME: ____________________________  

          (Your ID Code will be entered by us. Use it as your
           'Last name')

 PASSWORD FOR USG: ___________________ (Limit 8 characters)

SEXUAL PREFERENCE:  STRAIGHT: __  GAY: __  BI-SEXUAL __  LESBIAN: __
          (Check one of the above. See below)

      MARRIED: __  NEVER MARRIED: __  DIVORCED: __  WIDOWED: __  

      LIVE W/SOMEONE: ___  LIVE WITH RELATIVES: __  LIVE ALONE: __

      CHILDREN? (NUMBER + AGE(S)):_________________________________

      HEIGHT: _____  WEIGHT: _______  HAIR: ______ EYES: ______

      SUN SIGN: _____________   MONTH/DAY OF BIRTH: _______________
       (Aries/Gemini/ect)         (Like Jan 5 list as 01/05)

PURPOSE FOR JOINING: (Just for fun, looking for companion, marriage
just a friend, ect)

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

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INTERESTS: (Books, plays, sports,music, ect)

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

TELL US ABOUT YOURSELF: _______________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

TELL US WHAT YOU TYPE OF PERSON YOU ARE LOOKING FOR: __________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Information will be taken from this for your bio... BE SURE to look
over it on your FIRST CALL.. if you wish anything changed or deleted or
added  ADVISE AT ONCE!!


Signature:_____________________________________________________________


If you downloaded this form and HAVE NOT READ BULLETIN ON USG ... READ
IT BEFORE APPLYING!!!