Chapter registration form

From FreeCulture.org Wiki

• School name:
• Contact name:
  • Address:
  • Email:
  • IM:
  • Mobile phone:
  • Non-mobile phone:
• Chapter name:
  • Contact info:
    • Homepage:
    • Blog:
    • Wiki:
    • Mailing list:
  • Number of members (people who attend meetings):
  • Number of core team members (people who do work):
  • Are you registered with school? Yes/no
  • Do you have a budget? Yes/no
  • How big is your budget? (Give an estimate/range if you're not sure)
• Stuff you want (check boxes):
  • Free Culture t-shirts
  • Creative Commons
  • Electronic Frontier Foundation
  • Public Knowledge