1a. Your First Name:		(Required)
1b. Your Last Name:		(Required)
2. Title:
3. Organization:		(Required)
4. Type of Internet Provider:	Last Mile Middle Mile Last Mile & Middle Mile	(Required)
5. Please check the region(s) where your organization would be interested in participating:		(Required)
	Northern Corridor (Upper Peninsula)
	St. Ignace to Escanaba via Manistique Escanaba to Iron Mountain Powers south to Menominee Iron Mountain to Crystal Falls Crystal Falls to Ironwood via Watersmeet and Wakefield Watersmeet north to Ontonagon Ontonagon to Houghton
	Northeastern Corridor (Northern Lower Peninsula)
	Mackinaw City to Onaway via Cheboygan Onaway to Rogers City Rogers City to Alpena Alpena to Oscoda
	Middle Corridor (Central Lower Peninsula)
	Oscoda to Rose City Rose City north to Mio, Mio to Grayling Rose City south to West Branch West Branch to Lake City via Houghton Lake Lake City to Cadillac Cadillac to Luther Luther to Big Rapids
Organization Information
6. Organization Location:
Street Address:		(Required)
City:		(Required)
Zip Code:		(Required)
Method of Contact
7a. E-mail Address:		(Required)
7b. Phone:		(Required)
7c. Fax:		(Required)