Free eCommunity Web Space

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					                                    Order / Services Request Form                                   V4 12/02

                                    Free eCommunity Web Space

Please complete one agreement
per account

Individual/Organisation Name
(must be over 18 years or be
countersigned by guardian)

Please choose your preferred
username name. Your
username is used as your free
web address and appears after
the ~ for example.
This name must be between 4-8

HOW TO USE THIS FORM                 Please select one of these options to indicate your eligibility for free web space. Government agencies,
                                     schools and commercial organisations must use the VICNET Web Publishing Agreement form.
Please return this form signed
and dated to VICNET via post or           VICNET Volunteer                                        Personal Web Page
Please print clearly.                     Hobby/Special Interest Site                             VICNET Member
You will be notified via e-mail,          Community Group                                         Elected member of the Victorian Parliament
fax or letter of your account
details within two working days           (including health, sporting, artistic etc.)
of the receipt of your
You will be eligible for 10 MB of
                                     Other requirements:
web space, web statistics, free
beginners web design training
                                     Permission to have your site included in the PANDORA archive
class, free e-mail and phone           The PANDORA Project was set up in June 1996 at the National Library of Australia to preserve access
support weekdays and                   to Australian online information. The State Library of Victoria administers Victorian content. Tick the box
                                       if you agree to provide your permission to have your site included in the PANDORA archive. See
                              for more information about the PANDORA archive.
                                             Yes, I give permission to archive this site in the PANDORA archive.
                                     Request a Volunteer Web Designer
                                       Tick the box if you require assistance in completing your web site. VICNET will assign a volunteer to
                                       your project.
                                             Yes, I would like to request a VICNET Volunteer Web Designer.
                                       Describe the work required by the VICNET Volunteer Web Designer
Where did you hear about
VICNET? Please tick one of the

 □ from a VICNET customer,           Internet Services available at VICNET
                                       Please tick the box if you would like us to send you information about the following services:
 □ newspaper advertisement,
                                             Yes, please subscribe my e-mail address to the VICNET Zine (a monthly e-mail newsletter).
 □ television advertisement, or              Yes, please send me information about dial up Internet access.
                                             (available in Melbourne, Mallacoota and Apollo Bay)
 □ other (please specify).
______________________                       Yes, please send me information about VICNET’s permanent connection / DSL services
                                             (available in Melbourne, and parts of regional Victoria – check with VICNET for details.)
______________________                       Yes, please send me information about VICNET’s domain name services.

Signature of Parent/ Guardian
(for Applicants under 18 years)

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