Center for Technology Services
Please complete this form to add an E-mail list to the Region 14 Website.
Information
Please check the box that discribes your intent for this form.
Addition
Deletion
Modification
Modification Request (If checked above)
Please list any modifications your have for you E-mail List.
Component
Please select your component.
Name
This is the name of the person submitting the request.
E-mail address of person submitting request
This is the e-mail address of the person submitting the request.
Audience
This is the group(s) being targeted.
Name of E-mail List
This is the name that will appear on the web page and will be used to identify the list on the server.
Name of Moderator
Each list must have a moderator assigned to it.
E-mail address of Moderator
This is the e-mail address of the moderator of the e-mail list.
Director Notification
I have notified my Director that I am requesting this email list to be created.
Document # ADM-FOR-023
Date Created:11-3-08
Date Revised:
Revision #
Page 1 of 1
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