RAIN RAIN Internet Signup Form


Name:
Address:
City:
Zip:
Current Email:
Phone(Please include area code):
Fax(Please include area code):

How did you find out about RAIN?:
Name/Email address of RAIN member:
Name of Newspaper/Newsletter:
Name of Organizational Reference:
Other type of Referral:
Type of Account:
Type of computer system you use:
E-Mail Address (username) you would like (3-8 characters, letters and numbers only):
Password you would like (6-8 characters, non-dictionary word):

If interested in an automatic debit/payment system, please look into our Auto-Bill feature. After filling out this form and signing, please either fax it to (805)899-2823, or snail mail it to us at: RAIN Community Internet
PO Box 325
Buellton,CA. 93427


Type of Credit Card:
Credit Card Number:
Expiration Date:

Thank you for your support of RAIN's Public Internet Broadcasting Network!