Pcchead.gif (2261 bytes)  Membership Application/Renewal
Name: ___________________________________________

Address: _________________________________________

City/State: __________________________ Zip: __________

Home Phone: ______________________________   ___ Don't use

Work Phone: ______________________________       ___ Don't use

E-Mail Address: _______________________________    ____ Don't use

Computer Special Interests:       
___  Digital Photo/Scanning   ___ Office XP
___  Genealogy   ___  OS/2 
___  Hardware    ___  PDA-Palm O/S
___  Linux   ___  PDA-Pocket PC O/S
___  Media Mania  (Multimedia)   ___  Software
___  Money   ___  Windows 2000/ XP/2003
___ Net Games   ___  Windows 95 /98/ ME/XP Home
___   New Users  
___  Other:_______________________________________

 

   Date:__________________
   

___ New    ___ Renewal 

___ Regular   $35.00
___  65 and over   $20.00 
___  Student*   $20.00
___  Family**   $45.00 

*Must be full-time student. 
** For multiple members from the same household. Only one newsletter will be mailed.

Please note: Your home phone will be included in our club directory for use of members only. Your e-mail address will also be included in a directory for members only.
If you do not wish them to be published, please place a check mark at "Don't use."
Other Skills and Interests:   _______________________________________________________
____________________________________________________________________________

Computer Experience and Skills:  __________________________________________________
____________________________________________________________________________

Occupation: ______________________________________________________
Where did you find out about PC Clubhouse? 
____ Web Site ____  Friend:
____ Computer Show ____ Other:
____  Computer User Magazine    

Other Information about you:____________________________________________

Would you be willing to:
____ Help with the newsletter assembly ____ Lead a SIG (Special Interest Group)
____ Write articles for the newsletter ____ Help lead a SIG (Special Interest Group)
____ Review software and write reviews ____ Conduct a class for members
____ Work at a PCC booth at computer shows ____ Act as a mentor for other members
____ Telephone members as needed ____ Help with the refreshments for the main meeting

Please mail with your check to: PC Clubhouse, P.O. Box 55513, Hayward, CA 94545-0513 or bring this application and your payment to one of our meetings. 

03/03/06