You will also need to choose a family name. The name should be a proper surname, not a title, and not a "funny name". For example, if you choose "Doe" here, and later create a character named "Joe", he will be "Joe Doe". So don't choose "House Doe" or "The Mighty Does" as the family name, because that would make your character's name "Joe House Doe" or "Joe The Mighty Does" respectively - and that just sounds silly.
If you use whitelist software, please make sure that email@example.com has been added to your whitelist before submitting your application, or the e-mail that you need to confirm your address will bounce.