E-mail Address:

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Sex: Choose One Male Female

Age: Choose One Under 12 12-14 15-17 18-20 21-25 26-30 31-40 41-50 51-75 76-100 101-200 201+

Favorite Star Trek TV Show: Choose One Star Trek (TOS-The Original Series) Star Trek: TNG-The Next Generation Star Trek: DS9-Deep Space Nine Star Trek: Voyager Enterprise

Favorite Star Trek Movie: Choose One Star Trek: The Motion Picture Star Trek II: The Wrath of Khan Star Trek III: The Search For Spock Star Trek IV: The Voyage Home Star Trek V: The Final Frontier Star Trek VI: The Undiscovered Country Star Trek Generations Star Trek: First Contact Star Trek: Insurrection Thumbwars saga

How did you come to hear of Starbase-10? Choose One Friend Independence Fleet Site Independence Fleet Message archives I know someone in one of the IDF SIMs (put who in last box) Banner Exchange Search Engine Newsgroup/Forum Link Email AIM/ICQ/IRC Just surfing the net! Other - Please specify in last box

Previous Experience

Do you have any previous Star Trek Role Play By Email experience? Choose One Yes No Sorta (explain in last box)
If answer is "No", skip down to "Position Request"

What fleet were you last in?

What ship were you last on?

Position/job Held:

Highest Rank Achieved: Choose One Crewman Ensign Lieutenant-Junior Grade Lieutenant Lieutenant Commander Commander Captain Commodore Rear-Admiral Vice-Admiral Admiral Military rank (list in last box)

Position Request

What position/job do you want? Choose One Executive Officer Chief Engineering Officer Chief Intelligence Officer Chief Medical Officer Chief Operations Officer Chief Science Officer Chief Security Officer Chief Tactical Officer Assistant Engineering Officer Assistant Intelligence Officer Assistant Medical Officer Assistant Operations Officer Assistant Science Officer Assistant Security Officer Assistant Tactical Officer Astrometrics Specialist Communications Specialist Computer Specialist Weapons Specialist Ship Pilot Shuttle Pilot Fighter Pilot Military Posting Civilian Occupation (Specify in last box) Other, it's a LARGE facility (Please specify in last box)

2nd Choice: Choose One Executive Officer Chief Engineering Officer Chief Intelligence Officer Chief Medical Officer Chief Operations Officer Chief Science Officer Chief Security Officer Chief Tactical Officer Assistant Engineering Officer Assistant Intelligence Officer Assistant Medical Officer Assistant Operations Officer Assistant Science Officer Assistant Security Officer Assistant Tactical Officer Astrometrics Specialist Communications Specialist Computer Specialist Weapons Specialist Ship Pilot Shuttle Pilot Military Posting Civilian Occupation (Specify in last box) Other, it's a LARGE facility (Please specify in last box)

3rd Choice: Choose One Executive Officer Chief Engineering Officer Chief Intelligence Officer Chief Medical Officer Chief Operations Officer Chief Science Officer Chief Security Officer Chief Tactical Officer Assistant Engineering Officer Assistant Intelligence Officer Assistant Medical Officer Assistant Operations Officer Assistant Science Officer Assistant Security Officer Assistant Tactical Officer Astrometrics Specialist Communications Specialist Computer Specialist Weapons Specialist Ship Pilot Shuttle Pilot Military Posting Civilian Occupation (Specify in last box) Other, it's a LARGE facility (Please specify in last box)

Character Information

Name:

Sex: Choose One Male Female "Other" (specify in last box)

Race:

Home Planet:

Age: Choose One 20 yrs 21 yrs 22 yrs 23 yrs 24 yrs 25 yrs 26 yrs 27 yrs 28 yrs 29 yrs 30 yrs 31 yrs 32 yrs 33 yrs 34 yrs 35 yrs 36 yrs 37 yrs 38 yrs 39 yrs 40 yrs 41 yrs 42 yrs 43 yrs 44 yrs 45 yrs 46 yrs 47 yrs 48 yrs 49 yrs 50 yrs 51 yrs 52 yrs 53 yrs 54 yrs 55 yrs 56 yrs 57 yrs 58 yrs 59 yrs 60 yrs 61 yrs 62 yrs 63 yrs 64 yrs 65 yrs 66 yrs 67 yrs 68 yrs 69 yrs 70 yrs 71-100 101-200 201+ Other - Please specify in last box

Height: Choose One 5' 5'1" 5'2" 5'3" 5'4" 5'5" 5'6" 5'7" 5'8" 5'9" 5'10" 5'11" 6' 6'1" 6'2" 6'3" 6'4" 6'5" 6'6" 6'7" 6'8" 6'9" 6'10" 6'11" 7' Other - Please specify in last box

Weight: Choose One 100 lbs 105 lbs 110 lbs 115 lbs 120 lbs 125 lbs 130 lbs 135 lbs 140 lbs 145 lbs 150 lbs 155 lbs 160 lbs 165 lbs 170 lbs 175 lbs 180 lbs 185 lbs 190 lbs 195 lbs 200 lbs 205 lbs 210 lbs 215 lbs 220 lbs 225 lbs 230 lbs 235 lbs 240 lbs 245 lbs 250 lbs 255 lbs 260 lbs 265 lbs 270 lbs 275 lbs 280 lbs 285 lbs 290 lbs 295 lbs 300 lbs 305 lbs 310 lbs 315 lbs 320 lbs 325 lbs 330 lbs 335 lbs 340 lbs 345 lbs 350 lbs Other - Please specify in last box

Eye Color: Choose One Brown Blue Green Hazel Gray White Black Other - Please specify in last box

Hair Color: Choose One Black Brown Blonde Red Gray White Bald Other - Please specify in last box

Any additional comments:

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I agree to uphold the rules and regulations of both ID Fleet and SB-10: Choose One Yes No