MSGIC Membership Application

MSGIC website Please complete and submit this form in order to become a MSGIC member. Required fields are indicated in red and with a star (*). Examples are provided in small text where appropriate.
Name:*
Greeting:* First Name:* Middle Initial: Last Name:* Extension:
Mr, Mrs Jr., III, Ph.D.
Job Title:
GIS Technician  
Company/Agency:
 
Department/Division:
 
Building:
Smith Office Bldg.  
Floor:
2nd Floor  
P.O. Box/Mail Stop:
P.O. Box 143, E-2, 1C  
Street Address:*
Number:* Direction:* Street Name:* Street Type:* Section:*
654 N Central Avenue SW
City:* State:* ZIP Code* (Plus 4): -
 
Phone:* ( ) -   Ext.
 
Fax: ( ) -
 
Alternate Phone: ( ) -   Ext.
 
E-mail Address:
someone@inter.net  
My company or organization is best represented by:* 
 
Which sub-committee would you like to participate in?*
 
MSGIC would like to post your membership information on the MSGIC
website. Do you give your permission to do so? If you choose No,
only your name will be posted.*
 

   

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Please Note: This form is based on MSGIC's Recommendations on Addressing in Support of Address Matching and Geocoding.