Membership Application

COMPLETELY "FILL-IN" FORM ON-LINE USING YOUR KEYBOARD AND "TAB" KEY,
PRINT and MAIL WITH YOUR CHECK FOR CORRECT AMOUNT.


First Name:		Last Name:
Address:		Subdivision:
City:		Home Phone:
State: ZIP:		Current E-Mail Address: (IF ANY) EXAMPLE: johnqpublic@busy.net
Sign-on Name: (4-10 characters, alpha/numeric, MUST be in LOWER case)		Password: (4 - 8 characters, alpha/numeric, MUST be in LOWER case)
	Membership $45.00/yr includes Family & one e-mail account

We depend upon volunteers to maintain the quality and efficiency of the organization. Your participation will not only help the club, but help you to become more proficient on the computer. Please indicate any of your special fields of interest.
1. 2. 3. 4.
ADDITIONAL COMMENTS:
Alternate Address (for our Snowbirds -- USA only) Do you want your newsletter, BocaBits, mailed to another address for part of the year? If YES, complete the following:
Address:		Seasonal Home Phone:
City:		From Through mm/dd/yr mm/dd/yr
State: ZIP:

Complete this form, PRINT (click BUTTON below) and MAIL with your check:

For Office Use Only
Membership Number ________ Renewal Date ___/___/___ Check No. ______ Recommended By: ___________________

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Boca Raton Computer Society