Black Hats Registration Form

Who Are you? Title :

Mister. Missus Mzz (Cant find a bloke.) Mzz (don't wanna a bloke). All of the above. None of the above.

First Name :

Initial :

Last Name :

DOB (mm/yy) :

/ (date of birth)

Your Sex :

Male
Female
Spiritually aware New age Person

Whats your favorite drink?

Water. spirits Whine Diet Pepsi All of the above. None of the above. Tea with milk & sugar.

Computer type:

Apple
P/C
other
real computer


It will cost you $20 aus to join so fill in your details.


Visa
Master Card
Other
CREDIT CARD NUMBER


Expiry date shown on card..