MEMBERSHIP APPLICATION
May include two members of the same household.

Member No. 1 General Information

First Name        
Last Name          
Date of Birth     

Member No. 2 General Information

First Name        
Last Name          
Date of Birth     

Membership Information

Wedding Anniversary:        

Address 1          
Address 2          
City                     State      Zip    

Telephone 1          Cell           
Telephone 2          Pager        
Fax                   

e-Mail Address      

What are your computer interests? Please describe.

Are you interested in evaluating software for review in the newsletter? Yes No

Are you interested in teaching a Special Interest Group? Yes No