Membership Application

Membership Application Form

PROJECT SAFE GEORGIA

(There is no cost to be a member)

Fill in the form shown below, and press submit.  Use this form to be added to our Email  list. Thank you for your participation.

Last Name:      First Name:

Company/Organization:

Position: (Optional):

Title: (Mr. /Ms./Mrs./ Dr./ etc) :   Email Address:

Mailing Address:

City:   State:    ZIP:

Phone:    FAX      Cell:

Comments:

Please click on "Submit to Project Safe Georgia" to send your responses to PROJECT SAFE GEORGIA.  If you press "Reset," all of the information you have provided will be erased and you must begin again.  You may change any of your data before clicking on the "Submit" box.

Thank you!

"If you are already a member of Project Safe Georgia but are not receiving frequent emails from jimmy.mize@dol.state.ga.us you should email him to ascertain your email address is correct on the PSG database. If it is, you should contact your system administrator to have email from jimmy.mize@dol.state.ga.us allowed and not blocked as spam."

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