<div align="center">
<TABLE cellSpacing=6 cellPadding=0 border=0>
<TBODY>
<TR>
<TD valign="top">
<form name="formular" method="post" action="http://server1.webkicks.de/bugc/register.cgi">
<P align="center"><strong><span class="ueber">Chat Anmeldung<br>
</span></strong>
<CENTER>
<table width="0" border="0" cellspacing="5">
<tr>
<td>Alias:</td>
<td> <input class="input" name="user" size="15" maxlength="20" type="text">
</td>
</tr>
<tr>
<td>Passwort:</td>
<td> <input class="input" name="pass" size="15" maxlength="10" type="password">
</td>
</tr>
<tr>
<td>eMail:</td>
<td> <input class="input" name="mail" size="15" maxlength="100" type="text">
</td>
</tr>
<tr>
<td>Homepage:<br>
<small>(optional)</small></td>
<td>
<input class="input" name="hp" value="http://" size="15" maxlength="100" type="text">
</td>
</tr>
<tr>
<td>ICQ-Nummer:<br>
<small>(optional)</small></td>
<td><b>
<input class="input" name="uin" type="text" size="15" maxlength="100">
</b></td>
</tr>
</table>
<p>Die Freischaltung kann nur erfolgen, wenn<br>eine gültige Emailadresse angegeben wird!<br>
<BR>
<input name=job type=hidden value="sign">
<input name=cid type=hidden value="bugc">
<INPUT class="submit" TYPE="submit" VALUE="Anmelden" name="send-button">
</p>
</CENTER>
</FORM>
</TD>
</TR>
</TBODY>
</TABLE>
</div>
</body>
</html>