CSRNet Node Application Form
                        ~~~~~~~~~~~~~~~~~~~~~~~~~~~~



         Your Name: __________________________________________

          Your Age: _____    Your Birth Date:  __/__/__
                                               mm dd yy
Voice Phone Number: (   )    -

    Street Address: _________________________________
                    _________________________________
                    _________________________________
                    _________________________________
                    _________________________________


                BBS Name: ____________________________

        BBS Phone Number: (___) ___-____

    Current BBS Software: ____________________________
                          ____________________________

                 Mailer : ____________________________

       Crashmail Support: _____ Yes _____ No

             Modem Brand: ____________________________

           Max Baud Rate: ____________________________

             MNP Support: _____ Yes _____ No

      Hours Of Operation: ____________________________

 System Has Been Running: _____ Years _____ Months

 Approx. Number of Users: ____________________________

 Are you applying to be a HUB: ____ Yes ____ No

 If No, What is your HUB's CSRNet Address: ___________________

 Other Network Addresses: ____________________________

              Please complete the entire form and forward to:


                                Tim Lajoie
                     c/o The Collosus Soo Resource Net 
                       Data 16.8 USR DS (705)942-5370
                       Voice (9am-9pm)  (705)949-9275
                              CSRNet 11:11/0
                             FidoNet 1:222/21

 
                      Please make payments payable to:


                                 C.S.R.N.
                              c/o Tim Lajoie
                           122 Woodward Avenue
                    Sault Ste. Marie, Ontario, Canada
                                 P6A-3T7