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0022-3.564
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memform.txt
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Text File
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1992-03-01
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2KB
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36 lines
Atari Computer Enthusiasts (N.S.W.)
G.P.O. Box 4514, SYDNEY 2001 Fax Phone: 6658416
MEMBERSHIP FORM
-----------------------------------------------------------------------------
NAME :_____________________________________________________
ADDRESS :_____________________________________________________
TOWN/SUBURB:____________________________ STATE:____ POST CODE:_____
PHONES- Home (_____)______________ Work (_____)_______________
Enclosed is: [ ] Cash [ ] Cheque [ ] Money Order
[_] VISA [_] MasterCard [_] BankCard
------------------------------------------------------------------------------
Credit Credit Card
Card Number: [________]-[________]-[________]-[________] Expiry Date: ___/___
------------------------------------------------------------------------------
For:- [_] $35 ACE(NSW) New Membership [_] $30 ACE(NSW) Renewal
[_] $20 BBS Fee Only [_] $10 ACE MEMBER BBS Fee
SIGNATURE:________________ Date: ___/___/___
Please mark which ATARI model you own and Memory size.
STFM [_] or STE [_] or TT [_] Memory Size: ___________
SINGLE sided [_] 360K Drive or DOUBLE sided [_] 720K Drive
-----------------------------------------------------------------------------
OFFICE USE ONLY:
Date Processed:____/____/____ Renewal Due:__________ Receipt #:________
M/Card sent:[ ]
First Issue #:...... Last Issue #:...... MemberID #:...... StarterDsks:[ ]
------------------------------------------------------------------------------