:::nEcEssaRy appLicaNt iNfO:::
civiLiaN NamE {fiRst wiLL do}:
EmaiL addREss: {E.G.: you@domaiN.com}
locaTioN:
choosE a suitabLE NamE foR youRsELf as aN aNGEL Of Chaos.:
do you waNt youR iNfoRmaTioN dispLayEd oN ouR sitE? {notE: choosE "No" aNd oNLy youR a.o.c. NamE aNd othER commENts wiLL bE showN.}
why thE hELL Not??
Nah.
aRE you:
fEmaLE!
maLE!
aNy commENts?... spEciaLitiEs?...mEssaGEs to thE massEs?? aLso, LEavE youR wEbpaGE uRL if you havE oNE...