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First Name*:
Last Name*:
Organization*:

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Organization's URL:
Organization Type:
Industry:
Division Name:
Job Title*:
Are you the primary GIS contact for this organization or division?*:  Yes  No
   Do you wish to be approved as a metadata publisher?
 
Phone Number: ( )   
E-Mail*:
Alternate E-Mail:
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( * Please choose a Constituency Group. You will be notified of future New Jersey Geospatial Forum meetings via email.)
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Select Task Force(s)
(If you choose a Task Force, you will be notified of future Task Force meetings via email.)
 Boundaries
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Phone Number*: Yes  No  ( * May we publish your phone number?)
E-mail Address*: Yes  No  ( * May we publish your e-mail?)
 
Location  
Country*:

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State*:

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Street*:
Cross Street:
City:
Zip/Postal Code:
Username*:  ( * 4 to 14 alphanumeric characters only)
Password*:  ( * 4 to 14 alphanumeric characters only)
Retype Password*:
 
 
Identify Question*:
Answer*:
( * The Identify Question and Answer will help validate your identity in the event you forget your password.)