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MAIN - Metropolitan Austin Interactive Network
Client Application Form

Please complete every item on this form.

NOTE: Contact information needs to be for a representative of the organization that has been given authority by the organization's management to host a web site at MAIN.
Fields marked * are required
Organization Name:*
Contact Name:*
Organization's Postal Address:
Contact Phone (1st):*
Contact Phone (2nd):
Contact Email Address:*
Directory Name:
(your login ID, 12 chars. or less)
Description of Organzation:
Security Code:
Please enter the 5 character code you see in the image to the left.
BFN Secure Web Mail System
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Last Updated: 08/13/2009
MAIN.ORG P.O. Box 328, Bastrop, TX 78602 512-850-MAIN