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EAGALA Networking Group Agreement Signature Form

This form is to be filled out by the Networking Group Coordinator to formalize approval of the EAGALA Networking Group and service as the Coordinator. Please read the Networking Group Agreement and associated policies prior to filling out this form.

Name must be approved by the EAGALA Program Director

Indicate areas the group would cover - i.e. state(s)/country(s) or part of state(s)/country(s), province, region, postal codes

I, Coordinator of the Networking Group, have read, understand and agree to the following

Please type your initials in the spaces below indicating you have read, understand, and agree to the following

Please type in full postal mailing address

Please include country and area codes and indicate if it is your home, work, mobile, or other type of phone number. This is a phone number you are giving approval to make public on the EAGALA website.

This is an email you are giving approval to make public on the EAGALA website.

Type your full name in this space - this serves as approved electronic signature indicating your agreement to the above listed agreements and policies