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  1.                   ACGNJ MEMBERSHIP APPLICATION
  2.               Amateur Computer Group of New Jersey
  3.                            PO Box 319
  4.                    South Bound Brook, NJ 08880
  5.  
  6.  
  7. █ ▌ Ne≈ Membe≥                                  Due≤ arσ ñ14.00
  8. [ ] Renewal                             Foreign air mail  27.00
  9.               Please make checks payable to ACG-NJ
  10.  
  11. First name:__________________  Last name: _______________________
  12.  
  13. Mailing Address: ________________________________________________
  14.  
  15. City: ___________________ State: _____ Zip: ______ Country: _____
  16.  
  17. Business phone: (___) ___-____          Home phone: (___)___-____
  18.  
  19. [ ] Do not list me in the Membership Directory
  20. [ ] Electronic Engineer   [ ] Chemical Engineer  [ ] Programmer
  21. [ ] Student               [ ] Electronic Tech    [ ] DP Manager
  22. [ ] Systems Analyst       [ ] Consultant         [ ] Teacher
  23. [ ] Other, specify ____________________________________________
  24.  
  25. Who is your employer:__________________________________________
  26.  
  27. PART II:
  28. What topics would you like covered at club meetings:
  29.  
  30.  
  31. Would you like to speak at a club meeting? [ ] yes [ ] no
  32. Topic(s):
  33.  
  34. Can you help the club? [ ] general   [ ] newsletter  [ ] festival
  35. [ ] meetings  [ ] user group
  36.  
  37. What can you do?
  38.  
  39. PART III
  40. central processing unit
  41. 8080         Z80              6800/09          6502             Misc
  42. [ ] Imsai    [ ] TRS-80___    [ ] SWTP 6800    [ ] Apple_____   [ ] 1802 ____
  43. [ ] Altair   [ ] TDL/Xitan    [ ] SWTP 6809    [ ] Kim-1        [ ] TI
  44. [ ] Sol      [ ] HB           [ ] TRS-80       [ ] Comm _____   [ ] 8085
  45. [ ] HB       [ ] Cromenco __  [ ] HB           [ ] HB           [ ] 8086/8088
  46. [ ] Health   [ ] Sorcerer     [ ] Mot EK       [ ] OSI          [ ] IBM/PC
  47. [ ] Polym    [ ] Ithica Inter [ ] Heath        [ ] AIM          [ ] Dec_______
  48. [ ] other    [ ] Timex ___    [ ] other        [ ] other        [ ] 68000_____
  49.              [ ] Osborne                                        [ ] Z8000_____è----------   [ ] Kaypro       ______________   ____________     [ ] Fortune
  50.              [ ] Godbout                                        [ ] Other
  51.              [ ] Televideo
  52.              [ ] Sony                                            _____________
  53.              [ ] Epson ____
  54.              [ ] other
  55.               
  56.              ______________
  57.  
  58. Peripherals 
  59. Printer               CRT Term          Disk                 Misc
  60. [ ] TTY Mod:________  [ ] ADM _______   5"   8"              [ ] Modem
  61. [ ] Selectric         [ ] Hazel _____   [ ]  [ ] Tarbell     [ ] Music Syn
  62. [ ] Diablo            [ ] SWTP          [ ]  [ ] North *     [ ] DAC
  63. [ ] TI Mod:_________  [ ] Heath         [ ]  [ ] TRS-80      [ ] ADC
  64. [ ] Dec Mod:________  [ ] Soroc         [ ]  [ ] Apple       [ ] Prom Burner
  65. [ ] Centronix Mod:__  [ ] HB            [ ]  [ ] SWTP        [ ] Voice out
  66. [ ] Heath             [ ] Televideo     [ ]  [ ] Micropolis  [ ] Voice in
  67. [ ] IDS Mod:_____     [ ] other         [ ]  [ ] SD sales    [ ] Dazzler
  68. [ ] Epson Mod:_____                     [ ]  [ ] other       [ ] other
  69. [ ] TRS Mod: _____    -------------
  70. [ ] Okidata Mod:___                     -------------------   ______________
  71. [ ] other
  72.                                         [ ] Hard disk __________________
  73. --------------------         
  74.                                         DOS: ___________________________
  75.  
  76.  
  77.  
  78. Cassette type: ______________________________  Ram Size: ____________________
  79.  
  80. Video Board (specify) _______________________  Other Equip: _________________
  81.  
  82. ___________________ What do you plan to buy? ________________________________
  83.  
  84. Applications:
  85. [ ] Software development             [ ] Hardware development
  86. [ ] Word processing                  [ ] Process control
  87. [ ] Education                        [ ] Business
  88. [ ] Hobby                            [ ] Graphics
  89. [ ] Ham radio                        [ ] Music
  90. [ ] Games                            [ ] Scientific
  91. [ ] other:             
  92.  
  93. Comments:
  94.  
  95.