Silicon Vikings Membership

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Account information

Username: *

Your full name or your preferred username; only letters, numbers and spaces are allowed.

E-mail address: *

A password and instructions will be sent to this e-mail address, so make sure it is accurate.

Password: *

Please choose a password for your account; it must be between 6 and 30 characters and spaces are not allowed.

Confirm e-mail address: *

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Confirm Password: *

Please re-type your password to confirm it is accurate.

Personal information

First name: *

Last name: *

Permanent email: *

This email will only be used in case your primary email bounces and to ask you if you want to continue your membership. The content of this field is kept private and will not be shown publicly.

Street:

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City:

State:

Zip/Postal code:

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Daytime Phone:

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If you currently live in the US, then which year did you move here?:

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Location during daytime: --Peninsula (Palo Alto etc)South BayEast BayNorth BaySan FranciscoOutside of Bay Area

Location during evenings: --Peninsula (Palo Alto etc)South BayEast BayNorth BaySan FranciscoOutside of Bay Area

Country I live in: --USADenmarkEstoniaFinlandIcelandNorwaySwedenOther

Alternative web page/blog:

Home Country:

Country I was born in: --DenmarkEstoniaFinlandIcelandNorwaySwedenUSAOther

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Personal web page/blog:

Work information

Primary business of company:

Company/School/Org name:

Title:

Web address:

Work Street address:

Work City:

Work Zip/Postal code:

Work State:

Work phone:

Work country:

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