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/ BMUG Newsletter 1996 Fall / BMUG Fall 96 Newsletter ROM (BMUG) (1996).bin / BMUG Essentials / Membership Form.txt < prev    next >
Text File  |  1996-06-17  |  878b  |  39 lines
  1.  
  2. Name: ___________________________________   Date: ___/___/___   
  3.                                                                
  4. Company Name:    ____________________________________________
  5.         
  6. Address:    _________________________________________________
  7.         
  8. City:    __________________________ State: ________  Zip: ________
  9.  
  10. Country: _________________  Day Phone:    (______)______-________
  11.  
  12. ___ Cash
  13. ___ Check/Money Order
  14. ___ Credit Card
  15.  
  16. MasterCard/VISA# (please print) ______________________________
  17.      
  18. Expiration Date: ___/___   Signature:  ________________________
  19.  
  20. __ New Member
  21. __ Renewal
  22. __ Change of Address
  23.  
  24.  
  25. $28 - Six Month Membership
  26. $45 - Contributing Membership - one year
  27. $65 - Full Membership one - year
  28. $75 - Sustaining Membership - one year
  29. $100-Hero Membership - one year
  30.  
  31. Group Membership
  32. $85 - Family membership - one year
  33. $150 -  Small business - one year
  34.  
  35.  
  36.  
  37. June 1995
  38.  
  39.