[HELP NEEDED],can't understand some words in KR.

I wuld like to know what shuld i type in those 2 boxes.
http://i123.photobucket.com/albums/o...222/mgame3.jpg

http://i123.photobucket.com/albums/o...i222/mgame.jpg
Help would be greatly apreciated.It's for mgame registration BTW.