User Group Registration

User Group Name*

URL

Operating State/Province*

Group Leader*

Address Line 1*

Address Line 2

City*

State/Province*

Zip/Postal Code*

Country*

Phone

Email*

How often do you meet?

Number of group members?*

Group special interests/topics*

Other interests/topics

Do you have an Email mailing list?

Yes

Would your group members be interested in reviewing titles and publishing these reviews?

Yes