Print out this application and mail to
the address shown at the top of the form.

         M E M B E R S H I P  A P P L I C A T I O N

       National Capital Technology & Computer Users' Group, Inc.
                     201 S. Kensington Street
                 Arlington, Virginia  22204-1141
              Information phone number:  (301) 577-7899
	   Information email: plhoward@verizon.net

	  Trial membership: 6 month / 4 NL issues - $10
          Dues-$25 (US) yearly (add $5 for non-US addresses)
          Please mail check with application to above address.

(  ) New / 1 Year Member  (  ) Trial Membership  (  ) Address Change  (  ) Renewal


First Name:________________________________ Initial: ____

Last Name:_____________________________________________________

Mailing Address:________________________________________________________

                 _____________________________________________________________

City:_____________________________________

State:______ZIP:__________________

Telephone: (Home)(______)_______________________________________

(Work)(______)__________________________________________________


E-Mail Address: ________________________________________________

From what source did you hear about NCTCUG (Internet, member's name, etc.)?

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