Please Print
Organization Name:
____________________________________________________
Contact Person:
_______________________________________________________
Phone: ________________ Fax: ________________
E-mail: ____________________
Address:
____________________________________________________________
City, State, Zip:
________________________________________________________
Person responsible for updating website:
____________________________________
Phone: ________________ Fax:
________________ E-mail: ____________________
These names will be added to out BCN organization
mailing
list.
This allows us to keep you up to date
on BCN happenings.
Check all that apply:
___ I need a volunteer to help me create a web site.
___ Someone in my organization will create our web site.
___ I have registered with DIPP.
___ I will FTP/Fetch my files to BCN's incoming directory.
___ I wish to have the _______________ center be
my home directory and also
wish to be linked
under the following centers ________________________
___ Please call me, I am confused.
I am a legally recognized representative for the above stated
organization
(information provider).
On behalf of the organization, I have read and agree
to the terms of the
information provider contract.
Printed Name: ________________________ E-mail:
_________________________
Signature: ___________________________ Title:
___________________________
Date: _______________________________
(c) Copyright 1998 Boulder Community Network (version: 6.98)
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