. Member Application Form .

To Join SeniorNet Mac Inc. just print a copy of this page, fill in the details on the form and post it including the fee to the address shown below.

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 ...................

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

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
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.

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