Title
Name
Physical Address
Postal Address	Same as physical address
Email Address(es)
Telephone
Cellphone
Fax
Gender	Male Female
Age
Profession
Organisation
Website
Field(s) of Interest
Internet connection	Dial-up LAN
If Dial-up, choose Connection Speed	Select One 28 33 56
Operating system	Select One Windows 95 Windows 98 Windows NT Windows ME Windows 2000 Windows XP Linux Other
I access HSRC mail / internet from	Work Home