Talk121 - Chat Room Membership Application

	To become a member, complete the application form below and click the submit button. If you want to learn more about the benefits of joining Talk121, click here.
Member Name	Your member name will be the name you use to login and will be the name other users in the chat room will see you as.
Password	Your password must be between 6 and 12 characters.
Confirm Password
First Name
Last Name
Email
Year of Birth	(yyyy) You must be at least 18 years of age or older to join.
Sex
Comments

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