Membership Application

Application Type:

New Renewal Update Info  
  Membership #:  (renewal or update only)

Member Profile:

Name:    
Address: 
         
City:    
State:     ZipCode:
Phone #1: (Home)
Phone #2: (Work)
Fax:      (optional)
E-mail:  

Type of Membership (yearly):

Individual - $30  Family - $36  Group(5) - $120
Student - $24     Senior - $24

Method of Payment:

Check Money Order
Mastercard Visa  Exp./

Payment Notes: If paying by check or money order - complete the form, 
print this page, bring to next meeting with payment or mail with payment to: 
NSCS, P.O. Box 292, Peabody, MA 01960.

Credit Card Payment: If you are paying by credit card, please do not enter 
the account number or expiration date unless you are printing the form and 
sending it by mail. Please do complete ALL but the account information, 
give us a Phone #  and best time to call  
and then Submit the Application. We will then call you to ask you for 
the account number and expiration date.

Services of Interest:

Monthly Meetings Classes Workshops Computer Clinics
Special Events   Library Internet Access

Future Services of Interest:

E-mail Newsletter     Newsletter          Resource Center
Bulletin Board System Discounted Services Discounted Products
Other 

How did you hear about the North Shore Computer Society?

Would you be willing to volunteer your time to help the Society? Yes Not Now
If yes, in what capacity? (Newsletter, help at classes, clinics, meetings, etc.)

Is there anything else you would like to tell us at this time?