. Member Application Form .

To Join SeniorNet Mac Inc. print a copy of this page, fill in the details and post it including the fee to the address shown below. You can pay by direct banking see the bottom of this page.

I / we wish to apply to become member/members of SeniorNet Mac Inc. (Cross out which does not apply)

Surname: .............................................................. Partners Surname ..............................................

First or Given Names:.............................................Partners First Name ............................................

Actual Address: ...............................................................................................................................

Postal Address (if different from above): ...........................................................................................

City or Province: ............................................................................. Post Code:.................................

Phone Number:................................................Mobile Number ..........................................................

I am a NZ Citizen - Yes..... / .....No...... My partner is a NZ Citizen - Yes ..... / No ......

My email address is : ..............................................................................................

My occupation in life was: ....................................My Partner was ..............................

My birth date :......................................My Partners Birth Date :.................................

My / our Ethnic group is ......European ....... Maori ....... Pacific Island ...... Asian ....... (Please circle one)

My computer's model is:....................................The Operating System is OS10-........

I / we have an iPod ........... iPad ........... MacBook ........... iMac ............ iPhone ............

My Internet Connection is by.........Dial-up .............Broad Band .......or ..........Wireless

I wish to receive the Infoletter by NZ Post or by eMail (circle the which one you want)

How did you hear about SeniorNet Mac:.....................................................................

I / we are of mature age and agree to have my / our personal details given shown above being made available to SeniorNet Mac's data base for administration purposes.

Signature ............................................................... Date ....................................
PRINT a copy of this page then complete the form
Cost $30 (Single) - $50 (Couple) Cheque payable to SeniorNet Mac .................................... ... Add $10 extra if receiving your newletter by NZ Post
and send the completed form and cheque to

SeniorNet Mac Inc.
P O Box 475
Christchurch 8140

On receipt of the above application a help Booklet and infoletter will be sent to you.

----------------------------------Office only ----------------------------------------

If paying by direct banking, our bank account is as follows

020816 : 0376043 : 00

Add your surname and the word 'Sub'