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This form is to be filled out by the Networking Group Coordinator to formalize approval of the Eagala Networking Group and service as the Coordinator. Please read the Networking Group Agreement and associated policies prior to filling out this form.
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Name of Networking Group: (name must be provided by Regional Director)
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Networking Group location - areas covered: (Indicate areas the group would cover - i.e. state(s)/country(s) or part of state(s)/country(s), province, region, postal codes
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As Coordinator of this Networking group, I have read, understand, and agree to the following:
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Coordinator Address: (please type in full mailing address)
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Phone number for contact and public display on website: (please include country and area codes and indicate if it is your home, work, mobile, or other type of phone number. This is a phone number you are giving approval to make public on the Eagala website)
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Email address for contact and public display on website:
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Coordinator signature (signing below indicates agreement to the above listed agreements and policies):
