I have: (check one or both)
web skills the need for some or different web skills

First Name:         Last Name: 
Chapter:           
Mailing Address:   
Mailing Address 2: 
City :              State :  Zip: 
Daytime Phone:      Evening Phone:      
E-mail Address:      
Your home page:    

My chapter/state organization needs help with: (check as many as applicable)

  Learning more about the Internet in general
  Learning how the Internet can help our chapter
  Designing a web page
  Designing graphics for a web page
  Maintaining a web page
  Programming interactive web forms
  Teaching chapter members to maintain web pages
  E-mail consultations on technical Internet issues
  Phone consultations on technical Internet issues

I can: (check as many as applicable)

  Teach about the Internet
  Consult with a chapter on their Internet needs
  Design a web page
  Design graphics for a web page
  Program interactive forms for a web page
  Teach chapter members to design/maintain the web page
  Consult by e-mail with chapters as technical issues come up
  Consult by phone with chapters as technical issues come up



You can also print this form and return it to: 
Cybercoach, NOW, 733 15th Street NW, 2nd Floor, Washington, DC 20005.