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Expression of Interest Request Form

This is a request form only. All requests made through this process will be reviewed, but filing a request does not guarantee a license. Requests will be reviewed against available names and eligibility requirements. All information submitted is subject to review for accuracy, and additional information may be required. 

By completing the form below, you are providing information for review and verification purposes only.  All fields required:

In the field above, list the Domain Names you wish to apply for in .MED (separate each by a comma if more than one).
Digital Signature
 Security code

*By clicking Submit, I have read and understand the terms and conditions as stated within our Terms of Use statements.