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Title	First name(s)	Last name
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Email address:

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Web link:

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Areas of skill, experience and/or serious interest: (web programming / art / PR / engineer / etc.)

Affiliations with any other organizations:

PERMANENT related areas of PRIMARY expertise or serious interest:

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Address: (line 1)
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Address: (line 2)
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City	State/Province
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Home phone:		(this is kept private)
Work phone:		(this is kept private)
Mobile phone:		(this is kept private)

Please elaborate about your own work, organization, interests, skills, commitment level, and any other comments. This field is intended to be a public field so that others can get to know about you and/or your organization. For anything private, please send email instead.

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How did you find out about PERMANENT?

How serious are you about helping PERMANENT or a related organization? (not necessarily for PERMANENT)

Space development is my primary occupation or a most serious commitment in my life Major commitment - I will give as much time and effort as I can afford, and am very serious I don't have much time, but I will contribute my skills as best I can I can chip in a little bit of time, but don't want to take too much of your time I have no time right now, but might in the future, and here's my information for the record I will have no time, and right now just sending some information to you.