CA/HI/NV/Guam ESRI REGIONAL USERS' GROUP

Please use this form for membership application or change of address


Name:  ___________________________________________________      Date: _______       

                                                                                 

Title/position: __________________________________________      Federal     [  ]

                e.g., GIS mgr, planner, cartographer, etc.      State       [  ]

                                                                Local       [  ]

Agency/Company Name: _____________________________________      Academia    [  ]

                                                                Nonprofit   [  ]

Type of organization: ____________________________________      Private     [  ]

                       e.g., resource mgt, utility, etc.        Other ________
                                                                                 

Address (1) ______________________________________________      Ph: __________

        (2) ______________________________________________      FAX __________  

        (3) ______________________________________________      
                                                       
        (4) ______________________________________________
              City            State            Zip+4                             


E-mail      _______________________________________________
                                                              

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PLEASE COMPLETE THE FOLLOWING IF YOU ARE WILLING TO HAVE YOUR NAME PUBLISHED IN USER GROUP DIRECTORIES.

I, __________________________, give the CA/HI/NV/Guam ESRI Regional Users' Group 

my permission to maintain and to publish my name, work phone number and address

in a directory intended for their user community.  

      __________                       _____________________________________
         date                                        signature


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Questions?  
Contact: Chuck Johnson, Chairman  CA/HI/NV/Guam ESRI REGIONAL USERS' GROUP 
Phone: (916) 978-5266   FAX: (916) 978-5290 Email:  cbjohnson@mp.usbr.gov 


From:                                                                     STAMP




                           TO:  CA/HI/NV/Guam ESRI
                                REGIONAL USERS' GROUP

                                c/o Reg. GIS Program Manager
                                Attn: Chuck Johnson
                                US Bureau of Reclamation
                                2800 Cottage Way  (MP-400)
                                Sacramento  CA   95825-1898






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