This is the information to which I hope to gather when signing up members. If one wishes, they may print out this form, and mail it to the address below, or provide the information through an e-mail message. No dues are being taken at this time!!!!

To be filled out by individual, club, organization, or business:

Name:_________________________________________
Address:______________________________________
______________________________________
City:_________________________________________
State:_____________________
Zip Code:___________-______
Home Phone: _____-______-________
Other Phone:_____-______-________ Type:___________ (i.e. fax, pager)
_____-______-________ Type:___________
_____-______-________ Type:___________
_____-______-________ Type:___________
_____-______-________ Type:___________
_____-______-________ Type:___________
E-mail address:_______________________________
Web site URL:_________________________________
Additional Information:_______________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________

Signature:____________________________________ (Not required until payment begins)

Information to be filled in by Membership Chair:

Initial Contact Date:_________________________
Initial Contact Person:_______________________
Initial Contact Type:_________________________
Member Since:____________ (month/year)
Membership Type:______________________________
(Individual, non-profit, commercial)

Mail to:
Electronic Communications 2000
P.O. Box 2635
Gaithersburg, Maryland 20886-2635