Username: (optional) |
|
Password: (optional) |
|
Registrant's
Name: |
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Aero ENS auth ID: |
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Aero ENS auth key (from your SITA email): |
|
DNS
Server #1
(if known) |
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DNS
Server #2
(if known) |
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|
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Administrative |
Last Name: |
First Name: Title:
|
Prefered
Language |
Company/Organisation: |
Email
address: |
|
Second Email
Address: |
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Job
Title: |
|
Phone number: |
Fax number: Phone number #2: |
Address:
Unit Number: |
Street Name/Number: Street Type:
|
Office/Suite
Number: |
Postal/Zip Code: City: |
Province (if
in Canada): |
|
Country: |
|
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Technical : |
|
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Same as
Administative Contact |
|
|
Last
Name: |
First Name: Title:
|
Prefered
Language: |
Company/Organisation: |
Email address: |
|
Second Email
Address: |
|
Job Title:
(optional) |
|
Phone number: |
Fax number: Phone number #
2: |
Address:
Unit Number: |
Street Name/Number: Street Type:
|
Office/Suite
Number: |
Postal/Zip Code: City: |
Province (if
in Canada): |
|
Country: |
CIRA Membership:
|