ICLC Member Registration Form

Please note: Although it is most unlikely that you will experience any problems responding to this form, certain non-standard browsers will not respond properly. If you experience any difficulties, (or if you are not using a forms-capable browser) you may email your response to this form to: shwen@umich.edu.

Name (Family, Given):
Title (eg Cataloger):
Department (eg Catalog Dept):
Library Name:
Institution (eg Indiana Univ):
Street Address:
City, State/Province, ZipCode:
Country:
Work Phone Number:
Fax Number:
E-mail Address:
URL Address:
Research Interest:
Volunteer Area:
Other Suggestions:

WebForms™ 2.1b Professional Edition - ©1995 Q&D Software Development
http://www.q-d.com/