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1. Please provide the following contact information:

   First Name
   Last Name
   Middle Initial
   Phone
   FAX
   E-mail
   URL

2. Select any of the following areas of expertise:

   Network Specialist
   Web Designer/Developer
   E-Commerce Developer
   Application Developer/Programmer
   Software Migration Specialist
   Database Installation/Support Specialist
   Project or Account Manager
   

3. Select the areas of the U.S.A. you would accept assignments:

   Northeast-Maine, Vermont, etc.          East-New Jersey, New York,etc.           Southeast-Fla.,Georgia, Carolinas,etc.   North-N.Dakota,S.Dakota, Minnesota,etc.
   Midwest-Mo.,Illinois,Michigan,Ohio       South-Texas,Arkansas,Oklahoma,etc.    Northwest-Washington,Oregon,etc.       West-California,Utah,Nevada,etc.       
   Southwest-Arizona, New Mexcio,etc.   Telecommuter only (work at home)            

4. Would you like to be contacted for placement or to discuss opportunities?

   Yes No
   

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