Registration Form Thank you for your interest in joining Canville Virtual Village. Please review our Privacy Statement before signing up. Yes! I want to open an account on Canville Virtual Village right away! NOTE: Fields marked with an asterisk(*) are required fields. *Name: IMPORTANT: You must use your real name (first and last). We do not use handles or pseudonyms. *Address: *City: *State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Maryland Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *Zip: We respect your privacy. Your address will not be sold to third parties. Phone: Fax: *eMail: We respect your privacy. Your eMail address will not be sold to third parties. IMPORTANT: You must provide a valid eMail address. *Birthdate: You must be 13 or older to register for our services. * Select a password hint: Mother's Maiden Name: Last four digits of Social Security #: Favorite City: Favorite Dessert: Birthplace: Secret word or phrase: * (For verification purposes in case you lose or forget your password.) *Password Security Preference: Please send my user ID and password by U.S. Postal mail only. Please send my user ID and password to my eMail address listed above. Agreement: *Check box if you agree:I have read the Services Agreement provided on Canville Virtual Village and I agree to abide by all of the rules and regulations contained within. I have also read and understood the Privacy Statement and agree to the stated usage of any information I provide. I further state that all information provided by me for the creation of this account is truthful and accurate. IMPORTANT: The above checkbox for the Agreement must be checked if you wish to register for our services. If you do not agree to our Privacy Statement and Services Agreement, you should not submit this form. Where did you find out about Canville Virtual Village? Comments: IMPORTANT Please review the form before submitting. Fields marked with an asterisk(*) are required fields. Incomplete forms will not be processed. Forms containing invalid mailing addresses will not be processed. If you have not reviewed our Privacy Statement or our Services Agreement, please do so before submitting your information. After you have completed the form, please click the SUBMIT button to send us the information. Please visit our sponsor: Click on the ad above to visit.

Currently running Canville Virtual Village version 4.0a. This page has been visited 3875 times since 7 January 2002. The current time is 11:21 PM on 30 July 2010. “Canville Virtual Village” and “The Suburbs of the Information Superhighway” are service marks of Canville Communications. All other trade names referenced are the service marks, trademarks or registered trademarks of their respective companies. Art and contents Copyright 1996-2002 by Canville Communications. All rights reserved.