PLEASE PRINT CLEARLY if sending form by mail or printing in HTM or PDF  form.

   New  Renewal

Date: Membership# (only if renewal):

Last Name: First Name:
Address line #1:
Address line #2:
City/State: Zip Code:

Employer/Occupation:

Home Phone: Business Phone:

Email Address:

Type Of Computer You Use:

Brand:

Desktop Tower Both

RAM Size: Hard Drive1: Hard Drive2: Hard Drive3:

DRIVE TYPE

3 1/2 Zip Drive Tape Drive CD-ROM Optical Drive Others:

PAYING BY: Check Money Order

I Consider Myself: Beginner Intermediate Advanced User.

Five most frequently used programs: Level of Expertise: (Name of Program) (Beginner, Intermediate, Advanced) 1: 2: 3: 4: 5: ADDITIONAL PROGRAMS USED: 1: 2: 3: 4: 5:

One of the functions of CCUG-PC is to help members connect with others who have similar interests in computing. A roster is distributed periodically to the general members. If you have no objection to the publication of the above information, indicate by typing your name below. If not, please tell us below what information you wish kept confidential.

Name: What I would like Confidential:

Our club has many uses for your talents. We will be happy to explain the functions of each committee needing assistance. If you are able, please let us know if you can assist in various activities within the club, such as:

Newsletter Nominating Information Table Membership Photography/Video Christmas Party
Advertising SIG Leader Telephone Setup Other:

Your Membership in CCUG-PC will become active as soon as we receive your check or money order, and you will be notified on the day it is received.

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