Maine Prairie Procrastinator's Club
Membership Application

Title (if appropriate):

Email Address (loginname@domain.name):

Note: Be sure to use your complete email address (e.g., login_name@domain.name)

Your WWW Home Page address (if applicable):

Comments:

Select one:

I wish to have my name added to the MPPC roster.

I wish to have my entry changed on the MPPC roster.

Just a comment or question.

Be sure you have filled in a correct e-mail address.

     Please enter the letters shown in the image at the left in the box below