Application …

Application




                                                                    Membership Application/Renewal

    Name: ___________________________________________                                                            Date:__________________

    Address: _________________________________________
                                                                                                                 ___ New ___ Renewal
    City/State: __________________________ Zip: __________
                                                                                                                 ___ Regular            $35.00
    Home Phone: ______________________________ ___ Don't use                                                     ___ Over 65            $20.00
                                                                                                                 ___ Student*           $20.00
    Work Phone: ______________________________                            ___ Don't use                          ___ Associate**        $45.00

    E-Mail Address: _______________________________ ____ Don't use                                               *Must be full-time student.
                                                                                                                 **For multiple members from the
    Computer Special Interests:                                                                                  same household. Only one newsletter
    ___ Digital Photo/Scanning       ___ Office XP                                                               will be mailed.
    ___ Genealogy                    ___ OS/2
    ___ Hardware                     ___ PDA-Palm O/S
    ___ Linux                        ___ PDA-Pocket PC O/S                                                       Please note: Your home phone will
    ___ Media Mania (Multimedia)     ___ Software                                                                be included in our club directory for
    ___ Money                        ___ Windows 2000/ XP/2003                                                   use of members only. Your e-mail
    ___ Net Games                    ___ Windows 95 /98/ ME/XP Home                                              address will also be included in a
    ___ New Users                                                                                                directory for members only.
    ___ Other:_______________________________________                                                            If you do not wish them to be
                                                                                                                 published, please place a check mark
                                                                                                                 at "Don't use."

     Other Skills and Interests: _______________________________________________________
     ____________________________________________________________________________

     Computer Experience and Skills: __________________________________________________
     ____________________________________________________________________________

     Occupation: ______________________________________________________
    Where did you find out about PC Clubhouse?
    ____ Web Site                                                      ____ Friend:
    ____ Computer Show                                                 ____ Other:
    ____ Computer User Magazine

    Other Information about you:____________________________________________

    Would you be willing to:

    ____       Help with the newsletter assembly                         ____   Lead a SIG (Special Interest Group)
    ____       Write articles for the newsletter                         ____   Help lead a SIG (Special Interest Group)
    ____       Review software and write reviews                         ____   Conduct a class for members
    ____       Work at a PCC booth at computer shows                     ____   Act as a mentor for other members
    ____       Telephone members as needed                               ____   Help with the refreshments for the main meeting

    Please mail with your check to: PC Clubhouse, P.O. Box 55513, Hayward, CA 94540-0513 or bring this application and
    your payment to one of our meetings.




    12/04/04

http://www.pcc.org/membership/application.htm12/4/2004 1:36:56 PM