If you would like us to bill you for your membership dues to the
Hennepin County
GIS Users Group,
please fill out the billing information below*.
The Annual fee for membership is $10.00, and is for January through December, 2012.
First Name
Last Name
Organization Name
Your Title
Work Email Address
Work Phone Number
DID/Extension
Business Fax
Business Address
Business City
Business State
Business Zip Code
Home Address
Home City
Home State
Home Zip Code
Home Email Address
Home Phone Number
Membership Type
Government Agency
Individual
Corporate
Please E-mail my Bill to?
My Company
My Home
*Please note: It is not necessary to fill in all fields. However, we request that you provide us with
at least your name and organization, and one email, phone number, and address.