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Please tell us about yourself...

Mrs./ Ms. Mr. Dr.
First Name:                            *
Last Name:                             *
Address 1:                              *
Address 2:
City:                                        *
State/Province:                       *
Zip/Postal Code:                    *
Country:                                 *
Phone Number:
Cell Phone:
Pager/VoiceMail:
EMail Address:                      *

Do you have a personal Web page? *

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If YES, Web Address (URL):
IRC (Internet Relay Chat):

What is your gender? *
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What age group are you in?

How did you learn about this site?

Which site? 

Which Micrcomputer Platform & Web Browser do you own or use?


Which Western SubCultural Affiliation(s) best represent your essential indentity?



Cultural Affiliation -
Which Tribal Lineage best represents your blood or adoptive cultural identity?
(Feel free to choose an entry from each category's pulldown menu, as applicable)









Primitive Technologist -
Which area of Primitive Technology or Culture best represents your preferred technological specialization or cultural practice?
(Feel free to choose an entry from each category's pulldown menu, as applicable)

Primitive Technology -







Cultural Practice -



Spirituality
What area of spirituality best represents your spirituality beliefs?



Appropriate Technologist -
What area of Appropriate Technology best represents your specialization?




CyberPunk/Hacker -
Which area(s) of Microcomputer Technology best represents your specialization &/or area(s) of expertise?




Hippie/DeadHead -
Which area of Cultural Diversity best represents your Primary interests?

Which area of Cultural Diversity best represents your Secondary interests?



Modern Primitive -
Which means of artistic creativity have you utilized to express your identity?
I.  Body Art



III.  Other



If you would like for us to contact you, what is your preferred contact method?

Other

Please give us your comments here. We are especially interested in URL
submissions of any WebSites relevant to Primitive Technology. Thanks.



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