Thank you for your interest in the ICQ Over 40 user list.
To be added to the list, please fill out and submit this form.

Note: For items preceded by a *, answers are required.

* ICQ number

* ICQ user nickname

Real name (I will not publish any more of your name than what is already
shown in the ICQ directory)

* E-mail address (will not be published on the website)

Language or languages you wish to use

Gender (optional)

Age and/or birthdate (optional and doesn't have to be specific)

Marital status, location, hobbies, interests, personal information
(all optional; you may leave this area blank if you wish)

This is not an automatic form. A real person receives it and processes it.
If you have any special instructions for this person regarding your entry,
please write them below.