Hello. Would You like to become an Akiric? If so, simply fill out this form and submit it. All information is confidential and optional...

You identification number will be sent to you within two weeks...

1. What's your full name?
2. What's your screen name?
3. Any Nick-Names? If so, What are they?
4. When is your birthday?
5. And you wish to:	Join the Shrine Run Away Get more info Learn about members See neat Akira stuff Learn about Josta
6. What is your Social Security Number?
Remember: Filling out this form gets you in anyways! The above two boxes are just a joke...
Well, now comes the Private stuff...
(Remember this is all optional)
7. What is yur miling address?	,
8. What is your home phone number?
9. What is your work phone number?
10. What is your Fax number?
11. What is your Email address?
12. What Country do you live in?	United States Canada Mexico England Europe Germany Korea Japan China Australia Antartica Not listed above...
13. Number of Jostas consumed?	Too many to count... ?-10 11-20 21-30 31-40 41-50 51-100 101-200 201-300 301-400 401-500
14. Where did you learn about us?	A friend Expage Random Site Yahoo! School Work Family Member Other...
15. What planet do you live on?	Earth Mars Venus Jupiter Saturn Mercury Uranus Neptune Pluto Not listed...
16. Any Comments?
The Shrine of Akira thanks you for your time...
I'm sorry to say this, but sometimes an empty E-Mail box will appear when you press this button. If it does, please write your name, any thing else you feel will help us, and send it.