International Community Service
Coordinator Registration Form
===============================

//Coordinator Information -
Last Name=====>
First Name & MI=====>
Address=====>
City=====>
State & Zip=====>
Telephone (work/home)=====>
Fax=====>
Email=====>
Country of Origin=====>
Status (Student, Scholar, etc.)=====>
School Attending=====>

//Organization information -
Name=====>
Local Email Net=====>
Homepage (URL)=====>
Estimated Number of Members=====>

Comments (if any) -





//To Be Completed by ICS HQ -
Coordinator Identification No. (CIN) Assigned=====>
Starting Term/Year=====>

//Please return completed Registration Form:
     Email:   info@icsweb.org  [or]  i4cs@aol.com
     Fax:     (352) 331-0908
     Mail:    P.O. Box 141742, Gainesville, FL 32614-1742 (USA)

Questions? Please call ICS HQ at (352) 331-0087