Affiliate Channel Program Form (v1.0)

Instruction: Please fill in this form with all the required and proper 
             information and send this form using your web-based email 
             attachement utility to :-

                      affiliate@chatfriends.zzn.com


Personal Information
--------------------

Name:  
Age: 
E-mail Address: 
Country:

Channel Information
-------------------

Channel Name:
IRC Network:
Channel Purpose:
Channel URL:


Other Information
-----------------

Where do you get to know #chatfriends: (Please thick one)

          [] Yahoo! Search Engine.
	  [] Malaysian Cari Search Engine.
          [] From your friends.
          [] Someone from #chatfriends.
          [] Just bump in. 
          [] Heard it somewhere.
          [] Dunno. 
          [] Others. (Please specify) ______________________________


Thank you!