Galen's Membership Application Form

You must fill in all those marked with an *
First Name * Title
Last Name * Day Phone
Address * Eve Phone
Town/City
Country *
Existing Email County/State *
Existing Website
(Example: http://domain.com) 		Post/Zip Code *
Organisation Name Mobile Phone
Your Role Fax Number
Example: 'Club Secretary', 'Show Organiser', 'Veterinary Surgeon', 'VN'

NOTE TO APPLICANTS: You will be able to withhold the following information by editing your details when you are logged in: Title, Surname, Address, Town/City, Post/Zip Code, Day Phone, Eve Phone, Mobile Phone, Fax Number. You will also be able to choose which email address to use, your existing email or your free member's email address, to use on the contact form which visitors to the site can use to email you.

SERVICES: If you supply goods or services for specific rodents or exotics you will be able to specify that more finely, for example Degu, Dwarf Hamster, Syrian Hamster, Rat, Mouse, Sugar Glider etc when you log in to edit your details.
Please tick all that apply Cavy Chinchilla Exotics Rabbit Rodents
Boarding
Breeder
Club
Pet
Rehoming
Rescue
Show
Veterinary
Goods
Service
Choose which web site you want your web page and/or email address to be on
Choose a User Name**
**Use only lower case letters and numbers, no symbols, hyphens, full stops, special characters or underscores.
Your User Name will be used to create your web page address and also your email address and web site if you choose our free email address or web sit option
Password *
Confirm Password *
Password must be between 8 and 15 characters
Tick here if you want a free Email address Tick here if you want a free Web Site
Title of your Member's Page
Short Description Max 255 characters (plain text only)
This is the description that will be included in the search results when visitors search for information. It is also what search engines will use to describe your page when they return their search results.
Full Description
Font colour: Font size:
Font: Align:
This is the main information people will see when they go to your Member's Page. You will be able to edit this information when you are logged in.

We recommend that you DO NOT add email addresses to this description to avoid being bombarded by spam. A Mail To This Member link will be available on your personal page for people to contact you.
Logo for inclusion (optional) Note: Images will be resized to maximum height 120pixels
Acceptable image formats: jpg, png, jpeg
If you have chosen the web site option above you will be able to build proper pages with images of your choosing and then add a link to this to the main description.

I have read and agree to your Terms and Conditions*


 
Member's Log In
User Name
Password



Lost password

Search Directory