HVCN New Account Request Form

This is a NON-FUNCTIONAL demo version of a web page to be used to request your own personal account on HVCN.

Account Identification

You must fill out this portion completely.

Your Full Name:
Mailing Address:
Desired Login Name:

Each HVCN account must have a unique login name of no more than 8 characters. If the account you have selected is already in use, you will be given a chance to select another one.

Personal Information

The rest of this form asks you for various personal information. All of this information is optional. It's a nice way to let other HVCN users know a little bit about you. If you choose, it can be kept private so only the system administrators will be able see it. All of these fields are optional.

Date of Birth:

Telephone:

Sex:
Female
Male

What kinds of things are you interested in?

Privacy:
Check this box to prevent other users from being able to see any personal information except your name.

To reset the form, press this button: .

Press this button to submit your application: .

If this demo were a functioning form, the following paragraph would apply:
If this form is submitted filled out accurately with a legitimate mailing address, then you will shortly receive an HVCN contract in the mail. Your account will be created and activated within a few days after you sign the contract and return it to HVCN.