Heir Support Group Registration

HEIR publishes this information as a service to support groups and home educators seeking them.

If you are the contact person for a support group and wish HEIR to publish information about the group on its web site, in information packets, in the newsletter, etc., so that people may contact your support group, then please fill out the form below including only the support group information we may publish. Then "Submit it to HEIR." Thanks! Please also join HEIR using the HEIR Membership and Subscription form.

If you're on our website filling out this form, please ignore items with underlines rather than boxes.

Support Group Name: Date:__________ Event:____________

Area Served:
Support Group Description (limitations on membership, emphasis, activities, etc.):


Contact Information

You may publish my e-mail address as a way for people to contact my support group:
Yes
No
Email (something like xxxxx@xxxxx.com or .net - "@" required - your email is required even if you are denying permission to publish it):

You may publish my phone number as a way for people to contact my support group:
Yes
No
Phone (10-digit): Number:

Other Contact Information to Publish

FAX (10-digit): Number:

Postal Address:
Name:
Line 1:
Line 2:
City: State: Zip:

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10/14/00 modified
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