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New Account Creation – COPPA Request Form
Instructions for Parent or Guardian
According to the Childrens Online Privacy Protection Act of 1998 (COPPA) you must provide in written form this membership request form. The purpose of this request is to gain access as a ‘Registered Member’ of the dotNetBB forums found online at http://www.iislogs.com/forum/.
Upon completion please send the completed form by mail to :
Mail Address Unavailable

or fax to Fax Unavailable
Required Information
Real Name :
Please enter your real name (Administrative purposes only).
User Name :
Please enter a user name for your profile. This cannot be changed once selected.
Password :
Please choose a password you will remember (cannot be blank!).
E-Mail Address :
A valid e-mail address is required.
Parental or Guardian Approval
I have reviewed the information in the form provided and I am aware of the privacy policy available on the web site in question. I understand that the profile information may be changed by a using a password. I understand that I may ask for this registration profile be removed entirely.
Full Name of Parent or Guardian :
Signature :
Relationship to Child :
Contact Telephone :
E-Mail address of Parent or Guardian :
Today’s Date :
Please contact Steve Schofield at [email protected] with any questions regarding this form.
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