CARBON MONOXIDE SURVIVORS ASSOCIATION, international
                              (COSA,i)


                        'REGISTRATION FORM'

    This version of the 'REGISTRATION FORM' is to copy and paste into an email 

How to do this:

1. Use the "Ctrl-A" keys - (This means hold the "Ctrl" key down and then
press the "A" key. The whole 'join now' form page will then be color
highlighted on your screen.);

2. Use the same hold and press procedure with the "Ctrl" & "C" keys (this
copies into your computer what is highlighted);

3. Using your own email program, open a blank email page;

4. Click your cursor (arrow or vertical line) anywhere on the main body of
the blank email page;

5. Then hold and press the "Ctrl & "V" keys to paste (that is, place) the COSA 
form onto your blank email page;

6. Address the email to:    cosai@frontiernet.net

7. On the subject line, put 'COSA REGISTRATION FORM';

8. Complete the form by typing your information right in the form itself;

9. Send the completed email registration form to:
                           cosai@frontiernet.net




I.    See MEMBERSHIP page in the website and tell us the membership classification 
      you are applying for (check one or more of the following classifications,
      all as may be applicable to your circumstances).

__ a.     'GENERAL SURVIVOR' MEMBER;
__ b.     'PUBLIC INTEREST' MEMBER;
__ c.     'COMMERCIAL INTERESTS' MEMBER;
__ d.     'ACADEMIA' MEMBER;
__ e.     'CONSULTING' MEMBER.

II.   Your name (or company/group name): 

III.   Your e-mail address: 

IV.   Your mailing address 
                  Street or post office box number:

                                                                                                                     
                  City/town,.......... state..........zip code:


 
V.  Your home___     or business___ phone number________  _______  ____________
                                          (area code)
                                                 
                            ___fax number  ________  _______  ____________ 
                                          (area code)

VI.  If you will be a 'GENERAL SURVIVOR' member, please tell us if your CO involvement was 
              a. an acute one time exposure to CO ........_____ 
              b. a chronic (several episodes) exposure to CO ........_____  
              c. Or, both of the above types of exposure to CO ........_____

                    NOTE:  We will be collecting much more data relating to each 
                    member's individual CO experience(s) later on.  Watch this web site 
                    for future questionaires, etc. in this regard.

VII. TELL US ABOUT YOURSELF (try to use NOT MORE THAN 150 words....):


       If you will be a 'GENERAL SURVIVOR' member, tell us about your single
       most prevalent 'after effect' from your CO exposure(s);


       OR, if you will be a 'PUBLIC INTEREST' member, tell us what most
       concerns you about CO;


       OR, if you will be joining COSA,i as a 'commercial interest' member or 
       'academia', tell us about your product(s) and/or services 
       and/or your particular interest(s) in joining COSA,i. 


       OR, if you would like to join COSA,i as a consulting member, please tell us 
       about those area(s) of your professional expertise you feel could be of help 
       to our 'GENERAL SURVIVOR' members.


       OR ASK US QUESTIONS below!!!



VIII. FINANCIAL ASSISTANCE - 'VOLUNTARY CONTRIBUTIONS' - NOT A 
REQUIREMENT FOR 'GENERAL SURVIVORS' OR 'PUBLIC INTEREST' MEMBERSHIPS:

             YES, I believe 'COSA,i' can have a positive impact on my life...

      Please accept my enclosed contribution in the amount of $____
(send check or money order only, made payable to: COSA,i - please do not send 'cash').

EMAIL YOUR COMPLETED REGISTRATION FORM INFORMATION TO:
                              
                                 cosai@frontiernet.net


Send any financial aid you would like to contribute to our mutual cause to: 
            
                                  COSA,i
                                  19710 Maxwill Ave., North
                                  Marine, Minnesota 55047

                                  651-433-5779

                   ONCE AGAIN, WE THANK YOU FOR YOUR CONTINUING INTEREST 
                          IN WHAT WE ARE TRYING TO ACCOMPLISH!!!

                                          END