In the field "Nickname:", type in your Conservative Wiki user name. If you are not a registered user, it is best to create an account first. If you are already an IRC user, you can use the nick you have.
Do not change the field "#wikia-conservative". This is unless you don't want to connect to Conservative Wiki's channel, and you want to connect to another freenode chat.
In the field given for "reCAPTCHA:", type in whatever you see in the image immediately above. You need to include the spaces. If you want another image, press "Reload".
Press "Connect", the button at the bottom of the form.