Mailing List Information Form

Mailing List Information (Couples who wish to have both names in the database, please fill out separate forms for each person.)

Note: To receive a registration mailer just fill out the form below and click on the Submit Form button. Or you may click on this link and print out a form which you may fill out and mail to the address provided.

   Name:     Year of Birth: 

       Address: 

       City:    

       State:          Zip:  

       Phone:    

     e-mail Address:

If you wish to receive the registration mailer via e-mail (1 week earlier than via regular mail), Click on the checkbox below.

Computer Skills

         Non-User

         Beginner

         Intermediate

         Advanced

Computer you own

         None

         PC-Compatible/Windows

         PC-Compatible/DOS

         Macintosh

         Other/Don't Know

        Do you have a CD-ROM?    Yes       No

        Do you have a Modem       Yes       No