Please answer all questions as best you can. Incomplete forms will be discarded. The address you are exempting must be static. This means that you can not have an address that changes. We will not accept any applications that has a free email address for the ADMIN.

1. :Your Name
2. :Your E-mail Address
3. :IP address to be exempted
4. In what city is this site located?
   1. :City
   2. :State/Province/Region
   3. :Country:
5. :What is the name of the Administrator for this IP address?
6. :What is the Administrator's email address?
7. :What is the Administrator's phone number?
8. Why do you require a multiple connection exemption?
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