SAMPLE FORM - Submitted forms should look something like this.

   Name: (Name of person filling out form)
   E-mail: (& their e-mail address)

   1. REGISTRATION TYPE
   (N)ew (M)odify (D)elete..: New

   2. FULLY-QUALIFIED DOMAIN NAME: schooldistrict.k12.ks.us

   3. ORGANIZATION INFORMATION
   3a. Organization Name.....:Unified School Disctrict 100
   3b. Address Line 1........:100 South St.
   3b. Address Line 2........:
   3c. City..................:AnyCity
   3d. State.................:Kansas
   3e. ZIP Code..............:00000

   4. DESCRIPTION OF ORGANIZATION/DOMAIN: USD100 (any applicable description)

   5. Date Operational......:(The date you want this request to take effect)

(KanREN Staff used as example contacts):

   6. ADMINISTRATIVE CONTACT OF ORGANIZATION/DOMAIN (Must be complete)
   6a. NIChandle (if known)..:
   6b. Whole Name............: Doug Heacock
   6c. Organization Name.....: KanREN
   6d. Address Line 1........: 1802 Engel Rd.
   6d. Address Line 2........: 
   6e. City..................: Lawrence
   6f. State.................: Kansas
   6g. ZIP Code..............: 66045
   6h. Voice Phone...........: 785-864-0422
   6i. Electronic Mailbox....: heacock@kanren.net

   7. TECHNICAL AND ZONE CONTACT (Must be complete)
   7a. NIChandle (if known)..: JC1425
   7b. Whole Name............: Jake Chambers
   7c. Organization Name.....: KanREN
   7d. Address Line 1........: 2401 W. 25th St. #3B8
   7d. Address Line 2........: 
   7e. City..................: Lawrence
   7f. State.................: Kansas
   7g. ZIP Code..............: 66047
   7h. Voice Phone...........: 785-331-4334
   7i. Electronic Mailbox....: chambers@kanren.net
   7j. Registration Mailbox..: chambers@sunflower.com
   7k. Fax Number............: 785-331-4334

(This information can be obtained from you DNS provider):

   8. PRIMARY SERVER: HOSTNAME, NETADDRESS
   8a. Hostname..............: ns1.provider.net
   8b. IP Address............: 123.456.789.101

   9. SECONDARY SERVER: HOSTNAME, NETADDRESS
   9a. Hostname..............: ns2.provider.net
   9b. IP Address............: 123.456.789.102

   10. TERTIARY SERVER: HOSTNAME, NETADDRESS (Optional, Repeat as Necessary)
   10a. Hostname..............:
   10b. IP Address............: