"[@]" AT Gaming Society Membership Application

ALL FIELDS MARKED WITH A * ARE REQUIRED FIELDS.

Please fill out the form below and click "Submit", to process your Application to become a member of "[@]" AT Gaming Society.
You MUST fill out this form Accurately and Truthfully.
Failure to do so is just cause for immediate termination of membership at anytime from "[@]" AT Gaming Society.

* First Name: *

* Last Name: *

* Street: *

Apt/Flat/Room/Floor Number:

Post Office Box/Rural Route/Other:

* Postal/Zip Code: *

* City: *

* Province/State: *

* Country: *

* Phone Number: * Example:

* Date Of Birth: *

* Contact eMail Address: *

* Gender: *

* Please Tell Us What Your * In-Game * Name Is:
Also, How Long Have You Been Playing Multiplayer Games? *

* Please Choose The Main Game You Are Here For: *

BattleField 2
BattleField 2142
Armed Assault
UT 2004
ET: Quake Wars

Counter Strike
Counter Strike Source
Day Of Defeat
Day Of Defeat Source
Team Fortress 2

Guild Wars
World of Warcraft
Second Life
Silent Hunter III
HellGate: London

Age of Empires III
Falcon 4.0: AF
XBCONNECT
XBOX LIVE!
OTHER

* Who Referred You to "[@]" AT Gaming Society?
Don't See The Name Your Looking For? Then Choose "OTHER" or "ADVERTISEMENT"
Then Enter The Referral/Advertisement Name(s) In The Box Provided. *

* Have you ever been in a clan before? *

* Are you presently in a clan? *

If Yes, then Please tell us which clans and for which games

* Have you ever been a server admin before *

If Yes, then please provide us some details

* Do you know how to use TeamSpeak *

* Are you willing to use TeamSpeak *

If Not, Please tell us why

* Are you willing to travel for tournaments *

* What other Multiplayer Games do you currently play?
Please State "NONE" If You Play NO Other Multiplayer Games. *

* How would you rate yourself as a Gamer *
* Rough Estimation of hours played on a weekly basis *

* Are you applying for "Premium Membership" to "[@]" AT Gaming Society? *

If you selected "No" to the previous question, or if you would like to just donate please provide us with some details.
You can also use the box to the right to ask any questions regarding "Premium Membership" or "Donations".

* Please describe to us, a little bit, about yourself and your gaming habits *

We Would Appreciate Any Feedback About Our Membership Form
You May Use The Box To The Right For Your Comments. Thank You!

You May Use The Box To The Right to let us know if you have any skills or experience and wish to contribute to "[@]" AT Gaming Society

For Safety Against Fraudulent Applications, SPAM, or any other Harmful Activity
Your IP Address & ISP Information will be recorded and attached to your application.
This Information is NOT Given to ANYONE For Any Reason Except When Requested In Accordance To The Law.
Please Check The Box To The Right To Acknowledge Your Information Being Recorded.

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I Understand That My IP & ISP Information Are Being Recorded To Help Protect Myself & AT Gaming Society.