SNiP Internet Request Form

At this time, we do not have any free accounts available. SNiP has offered a discounted rate for any staff member. If you are interested in setting up this type of account, please contact Karen Allen in the Special Programs Office at ext. 9480.

Please print out this form and return as directed below.

Name:
Address:
City:	State:		ZIP:
Phone:
User Name: (Please give 2 choices)
1:		2:
Please circle responses.
CD-ROM Drive? Yes No
Operating System: Win. 3.1 Win 95 Win 98 Win 2000 Win XP Mac Power Mac

Please fill out form and return to B.Dalrymple or FAX to 7994. Thank you.