Coordinator Form
The FLGenWeb Project, Inc. appreciates your interest in caring for one of our County Sites or Projects.

Please
complete the form and submit it.

Your form will be reviewed by the
State Coordinator and board for approval.
Thank You for your interest.

Name *
Address *
City *
State *
Zip Code *
Email *
Alternate Email
Contact Phone # *
Position *
Birth Month & Birth Day *
Name of County *
USGenWeb Exerience *
Are you currently serving or have you previously served as a County Coordinator or Assistant County Coordinator in any USGenWeb State Project or Special Project?
If so, where and for how long?
I understand *
The FLGenWeb, Inc. is a not-for-profit Florida corporation and as such is required by Florida Statute Title XXXVI Section 617.1601 to maintain a list of members names and addresses.
Required
Signed ( Type your name in the box below) *
The FLGenWeb, Inc. is a not-for-profit Florida corporation and as such is required by Florida Statute Title XXXVI Section 617.1601 to maintain a list of members names and addresses.
Date *
(Transmission of this document to FlGenWeb Project, Inc. is your electronic signature)
MM
/
DD
/
YYYY
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