KINGMAN ARIZONA COMPUTER USER GROUP
MEMBERSHIP APPLICATION
Please complete this application and bring to the next monthly meeting.
with a check only for $12.00 payable to ( KACUG ) For club dues,
and give to the Membership Chairperson.
APPLICATION MUST BE FILLED OUT YEARLY WHEN PAYING DUES.
New: ( ) Renewal: ( )
( Please Type or print clearly and give your complete mailing address )
Last Name: ___________________ First: __________________ Intial: ____
Address:________________________________________________________
City: ___________________ State: _________ Zip: _______--_________
Day Phone: ( ___ ) ____ -_____ Evening Phone: ( ___ ) ____ - _____
Please enter your E-Mail address
E-Mail Address: ___________________ @ _______________________
How may we contact you? ( ) By Phone ( ) by E-Mail ( ) By Both
New Members that joining after march,
Dues are prorated at $ 1.00 per month for the remainder of the year.
Signature: ______________________________
Date: ________ / _______ / _________
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For Membership Chairperson Only
Amount Paid: $ ________ Check ( ) Cash ( ) Date Rec'd: _____/____/_____