Name:
  First      Last

Mailing Address:
  Street or P.O. Box
  (Apartment #, etc.)
  City
  State          Zip Code

Occasionally the Atlanta PC Users Group releases the mailing list to selected organizations and vendors for one time mailings. 
Do you wish to have your name released   +---+ Yes No

Internet Mail Address:
  E-Mail

Date of Birth: Used for verification only
  -Pick One- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day         Year (ex: 1987)
Phone Numbers
404 678 770 706 912 Area Code         Your Home Phone.
404 678 770 706 912 Area Code         Your Work Phone.

Annual Membership Level:          +--------------------------------------+ Individual - $30 (12 months) Family (2 People) - $45 (12 months) Family (3 People) - $60 (12 months) Family (4 People) - $75 (12 months)

Comments:

• Please verify that all information is correct
• Click the "Send e-mail" button below
• Print this page and send with a check made payable to:
  
  Atlanta PC Users Group
  P.O. Box 28788
  Atlanta, GA 30358