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................................................................................................................
Application to Join
SeniorNet Mac Inc.
I / we wish to
apply to become member/members of SeniorNet Mac
Inc.
(Cross out which does not
apply)
Surname:
.......................................................................
First or Given
Names:.....................................................................................................................................
...
Actual Address:
..................................................................................................................................................
Postal Address (if
different from above):
.....................................................................................................
City or Province:
.............................................................................
Post
Code:...............................................
Phone
number:.......................................................
NZ Citizen - .....Yes..... / .....No......
e-Mail address:
..............................................................................................
My main occupation in
life has been:
...............................................................
My / our birth dates is
/
are:..........................................................................
My / our Ethnic group
is ......European ....... Maori ....... Pacific Island
...... Asian ....... (Please circle)
My computer model
is:................................................................Operating
System OS......... ..............
How did you hear about
SeniorNet
Mac:..........................................................................................................................
.................................................................................................................................................................................................
I / we are of mature age
and agree to have my / our personal details given above
being
made available for the SeniorNet Mac Inc. 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 membership pack and course application will be
sent to you.
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