Enroll to Aussie Gay Cafe

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Confidential information (not to be displayed - except State and Country)

City
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Email:
Phone: (contact if there is a problem with your email account, messages bounce back)
First Name:
UserID: (your Alias like 'AwesomeOne', etc.)

Profile information (DOB will be converted to Age)

Date of Birth:
Occupation:
Gender:	Female Male
Your location:
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Eyes:
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Smoking:
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Relationship Type: (your profile will be found when this type selected)

Short Description: (make first impression, up to 128 characters)
Your Description: (formatting retained, e.g.: space, carriage return)


Do you want to receive updates from AGC by email: YesNo
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Membership

30 Day (1 Month) Membership $20.00
90 Day (3 Month) Membership $45.00
180 Day (6 Month) Membership $75.00

Payment Method
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Please confirm your email address:

If you are not paying by credit card, your account will be activated as soon as we receive your payment. Please make cheque payable to: WiNTSoft Consulting and mail it to (don't forget to write your Alias and email address):

Aussie Gay Cafe, PO Box 413, 2122 Eastwood, NSW, Australia

You can FAX payment details: +61+2+9475 0545

Or you can leave information by PHONE: +61+2+9512 6109

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Don't press 'Submit' twice to avoid double entry.)