Your Name :
Your Email Address :
Your Title :
Firm/Organization Name:
Address:
City:
State:
Zip:
Zip9:
Firm's/Organization's Phone Number :
Firm's/Organization's FAX Number :
Is your organization a FOR-PROFIT OR NOT-FOR-PROFIT?:
Do you currently have E-mail?:
How often do you check it?
How would you prefer to get info from the RIVERSIDE PAVILION?
Does your organization have a website?
Your URL: Note:"URL" = "Uniform
Resource Locator," i.e. the Web address
If you do not,
(There would be NO COST if you are a Not-For-Profit,
Would you be interested in attend a training session about Websites?
Do you have anyone in your organization
who could assist in developing / maintaining a site?
What area(s) does your organization service?
ORGANIZATION'S PURPOSE:
TYPES OF SERVICES WITH BRIEF DESCRIPTION:
ORGANIZATION'S HOURS OF SERVICE:
AGES SERVED:
COST OF SERVICE
INCOME GUIDELINES (if any):
OTHER ELIGIBILITY REQUIREMENTS,RESTRICTIONS,FORMS
How would you rate your knowledge of the Internet?
(Optional,but appreciated) How Did You Discover This Website?:
Referring Source:
The above information is accurate to the best of my knowledge