turn on email verification. No ifs ands, or buts. Turn it on. You need to take an automated spam bot out of the equation. That is how you do it. It also prevents the same person from registering over and over and over.
The http refer check is designed to stop someone from placing a posting from on a different website and using it to post on your forums. Probably not an issue.
When a user is banned they cannot sign up again. If the user is deleted they are removed from the system. System no longer knows about them, they sign right back up. If you have a trouble maker delete their posts, do not delete the user, just remove their rights.
If the name is one that is unacceptable change the displayed name to something more acceptable.
Lastly, turn on user moderation and manually approve all registrations. That will stop the problem in it's tracks.
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