| Username: (optional) |
|
| Password: (optional) |
|
| Registrant's
Name: |
|
| Aero ENS auth ID: |
|
| Aero ENS auth key (from your SITA email): |
|
| DNS
Server #1
(if known) |
|
| DNS
Server #2
(if known) |
|
|
|
| Administrative |
| Last Name: |
First Name: Title:
|
| Prefered
Language |
Company/Organisation: |
| Email
address: |
|
| Second Email
Address: |
|
| Job
Title: |
|
| Phone number: |
Fax number: Phone number #2: |
Address:
Unit Number: |
Street Name/Number: Street Type:
|
| Office/Suite
Number: |
Postal/Zip Code: City: |
| Province (if
in Canada): |
|
| Country: |
|
|
|
| Technical : |
|
|
Same as
Administative Contact |
|
|
| Last
Name: |
First Name: Title:
|
| Prefered
Language: |
Company/Organisation: |
| Email address: |
|
| Second Email
Address: |
|
| Job Title:
(optional) |
|
| Phone number: |
Fax number: Phone number #
2: |
Address:
Unit Number: |
Street Name/Number: Street Type:
|
| Office/Suite
Number: |
Postal/Zip Code: City: |
| Province (if
in Canada): |
|
| Country: |
CIRA Membership:
|