Howard
County Community Net
220 North Union
Street Kokomo, IN 46901-4614
Phone: 765.454.4705 Fax: 765.457.3683 Email: hccn@howard-county.net
If you wish to have your organization or business
become a member of HCCN, please fill out this form.
Name Of Organization or
Business:
___________________________________________________________________________________________
Address:
_______________________________________________________________________________________________________________________
Phone1:
___________________________________________________ Phone2:
__________________________________________________________
Fax:
_______________________________________________________ Web
Address:
___________________________________________________
Contact Person:
__________________________________________ Email Address:
___________________________________________________
Is your organization or
business __ non-profit or
__ for-profit?
Which category(s) best
describes your organization? (Please
choose up to 3 categories)
__ Arts/Culture/Entertainment __ Business __
Clubs
__ Education __
Employment/Job Services __
Environment
__Government/Politics __
Health/Medicine __
Libraries
__ Local Media __
Museums __
Parks/Recreation
__ Pets __
Philanthropic __
Religion
__ Social Services __
Sports __
Support Groups
__ Tourism __
Other __________________________
Describe your organization in 200 words or less on a separate sheet of paper (or submit it to us on a floppy disk)
and attach it to this form. Those individuals looking for your organization on the Howard County Community Net
will search the words you use in your description. Be sure to use words descriptive of your services, products or
mission. You may also enclose (on floppy disk or paper) a logo or graphic that you wish to be included on
your web page.
__
The information about our organization will change soon.
__
We do not wish to participate at this time.
Please contact us again after ________________________.
I
have read and understand the HCCN Development
Policy.
Signature
______________________________________________ Date ___________________________
If you have any
questions, please call the webmaster at 765-454-4710 or email
hccn@howard-county.net
This form may be mailed
or faxed to the address at the top of the form.
If you’d rather submit
your information online, please go to http://www.howard-county.net/addOrgForm.shtml