Verify password*　*パスワード（もう一度）

Country*　*国（Japanを選択）

Choose country... Afghanistan Albania Algeria American samoa Andorra Angola Anguilla Antarctica Antigua and barbuda Argentina Armenia Aruba Ascension island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and herzegowin Botswana Bouvet island Brazil British indian ocean Brunei darussalam Bulgaria Burkina faso Burundi Cambodia Cameroon Canada Cape verde Cayman islands Central african repub Chad Chile China Christmas island Cocos (keeling) islan Colombia Comoros Congo Congo, the democratic Cook islands Costa rica Cote d'ivoire Croatia (local name: Cuba Cyprus Czech republic Denmark Djibouti Dominica Dominican republic East timor Ecuador Egypt El salvador Equatorial guinea Eritrea Estonia Ethiopia Falkland islands (mal Faroe islands Fiji Finland France France, metropolitan French guiana French polynesia French southern terri Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bissau Guyana Haiti Heard and mc donald i Holy see (vatican cit Honduras Hong kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, democratic peo Korea, republic of Kuwait Kyrgyzstan Lao people's democrat Latvia Lebanon Lesotho Liberia Libyan arab jamahiriy Liechtenstein Lithuania Luxembourg Macau Macedonia, the former Madagascar Malawi Malaysia Maldives Mali Malta Marshall islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, federated Moldova, republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands antilles New caledonia New zealand Nicaragua Niger Nigeria Niue Norfolk island Northern mariana isla Norway Oman Pakistan Palau Panama Papua new guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto rico Qatar Reunion Romania Russian federation Rwanda Saint kitts and nevis Saint lucia Saint vincent and the Samoa San marino Sao tome and principe Saudi arabia Senegal Seychelles Sierra leone Singapore Slovakia (slovak repu Slovenia Solomon islands Somalia South africa South georgia and the Spain Sri lanka St. helena St. pierre and miquel Sudan Suriname Svalbard and jan maye Swaziland Sweden Switzerland Syrian arab republic Taiwan Tajikistan Tanzania, united repu Thailand Togo Tokelau Tonga Trinidad and tobago Tunisia Turkey Turkmenistan Turks and caicos isla Tuvalu Uganda Ukraine United arab emirates United kingdom USA United states minor o Uruguay Uzbekistan Vanuatu Venezuela Viet nam Virgin islands (briti Virgin islands (u.s.) Wallis and futuna isl Western sahara Yemen Yugoslavia Zambia Zimbabwe

Address*　*住所（番地、町村）

City*　*市区

State/Region*　*都道府県

Zip code*　*郵便番号（ハイフン無し７桁）

Date of birth　生年月日（上から年、月、日）一番下は空欄
You must be at least 18 years old to be allowed to join. If you are a Swedish citizen then you only have to be 16 years but then we also need the last four digits in your social security number to be able to pay you.

1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 I rather not tell
01 02 03 04 05 06 07 08 09 10 11 12 I rather not tell
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I rather not tell

Yearly income in dollars　年収（適当に選択）

5000$-10000$ 10000$-15000$ 15000$-25000$ 25000$-35000$ 35000$-50000$ 50000$-75000$ 75000$-100000$ >100000$ I rather not tell

I have a sound-card and loudspeakers　
サウンドカードとスピーカーを持っていますか？（どちらかに）

Yes No

Internet connection　インターネットの接続方法

Modem ISDN Cable T1+ I rather not tell

Paymentmethod　支払方法（通常はPayPalを選択）
You can choose betweenPaypal or E-Gold
E-Gold payments involve a 10% transaction fee due to the the high exchange fees with E-gold funding.

E-Gold Paypal

Your E-Gold account number:　E-Goldのアカウントナンバー（空欄）
This is so we know where to pay you

Minimum payment in US dollars (minimum is 5.00$ USD for E-Gold and 10.00$ USD for Paypal)*　*支払い希望金額（$10以上で入力）