Genesee Free-Net Individual Account Registration Form

  • warning: array_map() [function.array-map]: Argument #2 should be an array in /usr/local/4admin/apache/vhosts/ on line 1020.
  • warning: array_keys() expects parameter 1 to be array, null given in /usr/local/4admin/apache/vhosts/ on line 1832.
  • warning: Invalid argument supplied for foreach() in /usr/local/4admin/apache/vhosts/ on line 1832.



(All fields marked with an asterisk (*) are required)
Current e-mail address (if you have one):
Your name:

* First Name:   MI   *Last Name:
Your home address:
* Address:


       * City: * State: * Zip: -

Your phone:

     * Day phone: --
      Night phone: --
      Cell Phone:   --
In the event you forget your password, we need the following information for security reasons: 

     * your birth date:

     * your mother's maiden name:
I would like an individual account. Cost = $60 annual fee
I would like an individual account. Cost = $35 six month fee
If you are applying for an account and have an address outside of Genesee County, please verify that you have a local call-in number listed on our webpage. Please note that help calls to the office will be long distance if you are located outside of Genesee County:
Operating system:

PC or Mac:

I've read the Genesee Free-Net Acceptable Use Policy and agree to its terms.
*SIGNATURE___________________________________   DATE______________
Parent/guardian signature is required for users under the age of 18:
SIGNATURE___________________________________   DATE______________ 
PRINT this completed form and sign for mailing with your check. If you do not have a printer available, please call or write our office to request a form be mailed to you.