Old LLG Registration Form


 Name: ___________________________________________________________________
 Street Address: _________________________________________________________
 City, State, (Country), Zip: ____________________________________________
 Home Phone: ______________________ Work Phone: __________________________
 Internet Address: ____________________________________________________________________

 My primary interest(s) in Lojban are (check any that are applicable):
 ____ linguistics applications/theory _____ computer applications
 ____ foreign language/linguistics education _____'international' language
 ____ other: ______________________________________________________________

 Activity Level:
 _____ I am not interested in further involvement. Please remove me from your active lists.
 _____ (Level B-) Observer - (default)
 _____ (Level C) Active Supporter
 _____ (Level D) Lojban Student
 _____ (Level E) Lojban Practitioner

 Email this form to mailto:lojban@lojban.org, or snail mail to

 The Logical Language Group, Inc., 2904 Beau Lane, Fairfax VA 22031-1303 USA

Created by rlpowell. Last Modification: Sunday 04 of September, 2005 05:24:16 GMT by rlpowell.