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Please complete the following form to join centerNet.  Your personal information will not be shown on the website—only the description and name of the organization with a link to the website (if available).
Please complete the following form to join centerNet.  Your personal information will not be shown on the website—only the description and name of the organization with a link to the website (if available).
-
Your Name *
+
 
-
Region *
+
Your Name
-
Your Email *
+
 
-
Center Name *
+
Region
-
Description of Center *
+
 
 +
Your Email
 +
 
 +
Center Name
 +
 
 +
Description of Center
 +
 
Keywords
Keywords
 +
Website
Website
 +
RSS
RSS
 +
Phone
Phone
 +
Org. Fax
Org. Fax
 +
Center Email
Center Email
-
* Provide at least one form of contact.
+
 
 +
Provide at least one form of contact.
 +
 
Street Address
Street Address
 
 
City
City
 +
State/Province
State/Province
 +
Zip Code
Zip Code
 +
Country
Country
 +
Info (anything else you'd like us to know)
Info (anything else you'd like us to know)
   
   
-
* required
+
required
 +
 
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Powered by Business Directory for Wordpress
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== Translation ==
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= Translation =
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=== FRENCH ===
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== FRENCH ==
 +
 
 +
Complétez le formulaire ci-dessous pour rejoindre le réseau CenterNet. Vos informations personnelles ne seront pas visibles su rle site. Seule la description et le nom de votre centre seront publiés, avec un lien vers celui-ci (si disponible).
 +
 
 +
 
 +
Votre nom
 +
 
 +
Region
 +
 
 +
Votre courriel
 +
 
 +
Nom du centre
 +
 
 +
Description du centre
 +
 
 +
Mots-clés
 +
 
 +
Site (URL)
 +
 
 +
Flux RSS
 +
 
 +
Numéro de téléphone
 +
 
 +
Fax
 +
 
 +
Courriel officiel du centre
 +
 
 +
Fournissez au moins une modalité de contact.
 +
 
 +
Rue
 +
 +
Ville
 +
 
 +
Etat/Province
 +
 
 +
Code postal
 +
 
 +
Pays
 +
 
 +
Informations supplémentaires que vous souhaitez nous transmettre
 +
 +
obligatoire

Current revision as of 13:58, 30 September 2010

Please complete the following form to join centerNet. Your personal information will not be shown on the website—only the description and name of the organization with a link to the website (if available).

Your Name

Region

Your Email

Center Name

Description of Center

Keywords

Website

RSS

Phone

Org. Fax

Center Email

Provide at least one form of contact.

Street Address

City

State/Province

Zip Code

Country

Info (anything else you'd like us to know)

required

Powered by Business Directory for Wordpress

Translation

FRENCH

Complétez le formulaire ci-dessous pour rejoindre le réseau CenterNet. Vos informations personnelles ne seront pas visibles su rle site. Seule la description et le nom de votre centre seront publiés, avec un lien vers celui-ci (si disponible).


Votre nom

Region

Votre courriel

Nom du centre

Description du centre

Mots-clés

Site (URL)

Flux RSS

Numéro de téléphone

Fax

Courriel officiel du centre

Fournissez au moins une modalité de contact.

Rue

Ville

Etat/Province

Code postal

Pays

Informations supplémentaires que vous souhaitez nous transmettre

obligatoire

Personal tools