DELEGATED MANAGER UPDATE TEMPLATE v1.0

      1.   ORGANIZATION INFORMATION 
           Please indicate if your organization is
           (1) a state or local government entity  
           (2) A state or local government agency (e.g.-school district, public library, etc.)  
           (3) A not-for-profit organization  
           (4) An individual  
           (5) An Internet Service Provider  
           (6) An Internet Domain Registrar  
           (7) Other Internet Company  
           (8) Other
      1a.  Organization Type...........*:
      1b.  Details for Other............:

      2.  REGISTRATION INFORMATION
      2a.  Registration Email Address..*:

      3.   PERSONAL CONTACT INFORMATION (of person completing form)
      3a.  Contact Name (Last, First)..*:
      3b.  Organization Name...........*:
      3c.  Address Line 1..............*:
      3d.  Address Line 2...............:
      3e.  Address Line 3...............:
      3f.  City........................*:
      3g.  State.......................*:
      3h.  ZIP Code....................*:
      3i.  Phone.......................*:
      3j.  Fax..........................:
      3k.  Email.......................*:

      4.   DELEGATED MANAGER INFORMATION
      4a.  Contact Name (Last, First)..*:
      4b.  Organization Name...........*:
      4c.  Address Line 1..............*:
      4d.  Address Line 2...............:
      4e.  Address Line 3...............:
      4f.  City........................*:
      4g.  State.......................*:
      4h.  ZIP Code....................*:
      4i.  Phone.......................*:
      4j.  Fax..........................:
      4k.  Email.......................*:

      5.   ADMINISTRATIVE CONTACT OF ORGANIZATION/DOMAIN
      5a.  Contact Name (Last, First)..*:
      5b.  Organization Name...........*:
      5c.  Address Line 1..............*:
      5d.  Address Line 2...............:
      5e.  Address Line 3...............:
      5f.  City........................*:
      5g.  State.......................*:
      5h.  ZIP Code....................*:
      5i.  Phone.......................*:
      5j.  Fax..........................:
      5k.  Email.......................*:

      6.   TECHNICAL AND ZONE CONTACT
      6a.  Contact Name (Last, First)..*:
      6b.  Organization Name...........*:
      6c.  Address Line 1..............*:
      6d.  Address Line 2...............:
      6e.  Address Line 3...............:
      6f.  City........................*:
      6g.  State.......................*:
      6h.  ZIP Code....................*:
      6i.  Phone.......................*:
      6j.  Fax..........................:
      6k.  Email.......................*:

      7.   PRIMARY SERVER: HOSTNAME, NETADDRESS
      7a.  Hostname....................*: lsd.chicago.il.us
      7b.  IP Address..................*: 204.248.57.218

      8.   SECONDARY SERVER: HOSTNAME, NETADDRESS
      8a.  Hostname....................*: dns.mensa.org
      8b.  IP Address..................*: 216.234.242.97
      (repeat 8a and 8b as many times as required)

      9.   DELEGATION INFORMATION:
      9a.  Delegated Zone (Domain Name)..............*:
      9b.  Date of Delegation (YYYY-MM)*:
      (repeat 9a and 9b as many times as required)

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