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Text File  |  1992-02-29  |  2KB  |  36 lines
  1.                    Atari Computer Enthusiasts (N.S.W.) 
  2.              G.P.O. Box 4514,  SYDNEY 2001  Fax Phone: 6658416
  3.                             MEMBERSHIP  FORM 
  4. -----------------------------------------------------------------------------
  5.  
  6.     NAME       :_____________________________________________________
  7.  
  8.     ADDRESS    :_____________________________________________________
  9.  
  10.     TOWN/SUBURB:____________________________  STATE:____ POST CODE:_____
  11.  
  12.     PHONES-  Home (_____)______________    Work (_____)_______________
  13.  
  14.  Enclosed is:  [ ] Cash    [ ] Cheque         [ ] Money Order
  15.                [_] VISA    [_] MasterCard     [_] BankCard
  16. ------------------------------------------------------------------------------
  17.   Credit                                          Credit Card
  18. Card Number: [________]-[________]-[________]-[________]  Expiry Date: ___/___
  19. ------------------------------------------------------------------------------
  20.        For:- [_] $35 ACE(NSW) New Membership   [_] $30 ACE(NSW) Renewal
  21.              [_] $20 BBS Fee Only              [_] $10 ACE MEMBER BBS Fee
  22.  
  23.                  SIGNATURE:________________   Date: ___/___/___
  24.  
  25.      Please mark which ATARI model you own  and  Memory size.
  26.  
  27.       STFM [_]   or   STE [_]   or   TT [_]       Memory Size: ___________
  28.  
  29.          SINGLE sided [_] 360K Drive   or  DOUBLE sided [_] 720K Drive
  30. -----------------------------------------------------------------------------
  31. OFFICE USE ONLY:
  32.  Date Processed:____/____/____ Renewal Due:__________ Receipt #:________
  33.                                                                M/Card sent:[ ]
  34.  First Issue #:......  Last Issue #:......  MemberID #:......  StarterDsks:[ ]
  35. ------------------------------------------------------------------------------
  36.