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SPUG COMPUTER CLUB MEMBERSHIP APPLICATION

(Please print) If you are interested in joining the SPUG Computer Club, please print out this form, fill it in, and mail with your check to:

Greg Nergenah, 1413 Seqipoa Dr.,Chatham, IL 62629

All information on the membership application is for the exclusive use of the SPUG Computer Club and will not be made available to anyone outside the club.

Annual dues are $20, which is for the household, all members of which may participate. Members of your household desiring a separate vote, to hold a separate office, etc., may obtain an Associate Membership for a small additional fee.

Full Name__________________________Address____________________________________

City_______________________________State________________ZIP___________________

Phone Number (Home)___________(Work)______________E-mail Address________________

Computer Type(s) owned_______________________Operating System____________________
Printer Type(s)________________________Peripherals:Modem___________CD-ROM_______
Scanner___________________Other_______________________________________________

Computer Interests

Games_________Art/Graphics___________Word Processing_______________Music_________
Accounting/Spreadsheets______________Telecommunications______________Internet_________
Video Processing____________________Other_______________________________________

Skill Level

Beginner________Intermediate__________Advanced/Skilled___________Do you program?______

Comments or questions (write in below free space) or call Greg Nergenah at 217-483-9519. Or e-mail him at: gnerg1969@yahoo.com

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