ConnCHI Membership Application Form

If you would like to join ConnCHI or simply be added to the official
ConnCHI mailing list, please fill-out and submit the form below.

If your browser is not configured for e-mail and you use a different e-mail client, send a note to Matthew Stroop at mstroop@us.ibm.com and express your interest in joining ConnCHI.

Please complete the entire form:

Name
Company
Department
Title
E-mail
Preferred address	Home   Business
Address-1
Address-2
Address-3
City, State, ZIP
Phone
Fax
ACM Membership Status	Voting Associate Student Prospective Affiliate Subscriber _____________________
SIGCHI Membership Status	Voting Associate Student Prospective Affiliate Subscriber _____________________
ConnCHI Membership Status	Regular Student Add to mailing list _____________________
Volunteer to help ConnCHI	Not at this time Program Committee Information Committee Membership Committee Secretary/Treasurer Willing to help Willing to speak _____________________