Membership Application.

Name: ___________________________________________________

Mailing Address: ___________________________________________

City, State, Zip: ____________________________________________

Home Phone: (_______) ____________________________________

Work Phone: (_______) _____________________________________

Occupation: _______________________________________________

Employer: _________________________________________________

Email Address: _____________________________________________


This Application is for the following:

New Member: ______

Renewal: _____    Provide membership number: ___________________

Address Change: ______


Annual Dues: $35.00
Additional membership cards: $2.50 each (at time of membership or renewal)


My enclosed tax-deductible contribution: _______________

Enclosed Check #: ______________    Total Payment: ______________



Send form and payment to:
Columbus Computer Society
Attn: Cindy Cramer
P.O. Box 44069
Columbus, OH 43204-0069