Margins: Bottom: .5"

PA REGISTRY User Identity,
MAILBOX / MAXC / IVY Account* Application
and SECURITY ACKNOWLEDGEMENT
(Form to be used by Xerox PARC employees only)
*Not Files-Only

User Name: Password:
(Preferably your last name ending with .PA) (6 or more letters and/or digits and unpronounceable)

Grapevine
Organization and Lab: MAILBOX
MAXC:
explain requirement
Location:File access only
MAXC
Temporary EmployeeFull service:
Anticipated termination date:explain requirement
File access only
IVY
File storage rights

Security Acknowledgement:

I acknowledge my responsibility to protect any information (processed and/or stored under the above directory) which is derived from classified or proprietary company information or should be so treated under corporate policy. I understand the protection features available for this purpose provided by the Maxc/Tenex system. In addition, I will protect the directory from any unauthorized disclosure or use and I will keep my password in strict confidence.

Originator’s Name: Date:
please print
Originator’s Signature: Phone:

Supervisor’s Name:Date:
please print
Supervisor’s Signature:Phone:

Do not write below this line

User Groups:

Directory Groups: Person responsible for this directory if owner

File Protection: terminates:

Directory Protection:

Project Group: Disk Limit:

Remarks:


Maxc Account No. Date created: by:

Authorizing Signature: Date:


MAXC USER ACCOUNT STATUS:

ActiveInactiveTerminated
Date of Termination

Filed on [Indigo]<Forms>PARegistryAppl.Press