home *** CD-ROM | disk | FTP | other *** search
/ Oakland CPM Archive / oakcpm.iso / sigm / vol157 / join.acg < prev    next >
Text File  |  1985-03-14  |  4KB  |  90 lines
  1.                   ACGNJ MEMBERSHIP APPLICATION
  2.               Amateur Computer Group of New Jersey
  3.                            PO Box 319
  4.                    South Bound Brook, NJ 08880
  5.  
  6.  
  7. █ ▌ Ne≈ Membe≥                                  Due≤ arσ ñ14.00
  8. [ ] Renewal                             Foreign air mail  27.00
  9. [ ] Address change
  10.               Please make checks payable to ACG-NJ
  11.  
  12. First name:__________________  Last name: _______________________
  13.  
  14. Mailing Address: ________________________________________________
  15.  
  16. City: ___________________ State: _____ Zip: ______ Country: _____
  17.  
  18. Business phone: (___) ___-____          Home phone: (___)___-____
  19.  
  20. [ ] Do not list me in the Membership Directory
  21. [ ] Electronic Engineer   [ ] Chemical Engineer  [ ] Programmer
  22. [ ] Student               [ ] Electronic Tech    [ ] DP Manager
  23. [ ] Systems Analyst       [ ] Consultant         [ ] Teacher
  24. [ ] Other, specify ____________________________________________
  25.  
  26. Who is your employer:__________________________________________
  27.  
  28. PART II:
  29. What topics would you like covered at club meetings:
  30.  
  31.  
  32. Would you like to speak at a club meeting? [ ] yes [ ] no
  33. Topic(s):
  34.  
  35. Can you help the club? [ ] general   [ ] newsletter  [ ] festival
  36. [ ] meetings  [ ] user group
  37.  
  38. What can you do?
  39.  
  40. PART III
  41. Central Processing Unit
  42. 8088         Z80/8080         6800/09          6502             Misc
  43. [ ] IBM-PC   [ ] TRS-80___    [ ] SWTP 6800    [ ] Apple_____   [ ] 1802 ____
  44. █ ▌ IBM-X╘   █ ▌ TDL/Xitaε    █ ▌ SWT╨ 680╣    █ ▌ Kim-▒        █ ▌ T╔-9900
  45. [ ] IBM-JR   [ ] HB           [ ] TRS-80 Color [ ] Comm _____   [ ] 8085
  46. [ ] Compaq   [ ] IMSAI___     [ ] HB           [ ] HB           [ ] 68000    
  47. [ ] Columbia [ ] North Star   [ ] Mot EK       [ ] Atari __     [ ] Z8000 
  48. [ ] Seequa   [ ] Altair       [ ] Heath        [ ] AIM          [ ] DEC _____
  49. [ ] other*   [ ] other*       [ ] other*       [ ] other*       [ ] other*    
  50.  
  51. *Specify:____________________________________________________________________
  52.  
  53. Peripherals 
  54. Printer               CRT Term          Disk                 Misc
  55. [ ] TTY Mod:________  [ ] ADM _______   5"   8"              [ ] Modemè[ ] Selectric         [ ] Hazel _____   [ ]  [ ] Tarbell     [ ] Music Syn
  56. [ ] Diablo            [ ] SWTP          [ ]  [ ] North *     [ ] DAC
  57. [ ] TI Mod:_________  [ ] Heath         [ ]  [ ] TRS-80      [ ] ADC
  58. [ ] Dec Mod:________  [ ] Soroc         [ ]  [ ] Apple       [ ] Prom Burner
  59. [ ] Centronix Mod:__  [ ] HB            [ ]  [ ] SWTP        [ ] Voice out
  60. [ ] Heath             [ ] Televideo     [ ]  [ ] Micropolis  [ ] Voice in
  61. [ ] IDS Mod:_____     [ ] other         [ ]  [ ] SD sales    [ ] Dazzler
  62. [ ] Epson Mod:_____                     [ ]  [ ] other       [ ] other
  63. [ ] TRS Mod: _____    -------------
  64. [ ] Okidata Mod:___                     -------------------   ______________
  65. [ ] other
  66.                                         [ ] Hard disk __________________
  67. --------------------         
  68.                                         DOS: ___________________________
  69.  
  70.  
  71.  
  72. Cassette type: ______________________________  Ram Size: ____________________
  73.  
  74. Video Board (specify) _______________________  Other Equip: _________________
  75.  
  76. ___________________ What do you plan to buy? ________________________________
  77.  
  78. Applications:
  79. [ ] Software development             [ ] Hardware development
  80. [ ] Word processing                  [ ] Process control
  81. [ ] Education                        [ ] Business
  82. [ ] Hobby                            [ ] Graphics
  83. [ ] Ham radio                        [ ] Music
  84. [ ] Games                            [ ] Scientific
  85. [ ] other:             
  86.  
  87. Comments:
  88.  
  89.  
  90.