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Capitol Macintosh Membership Application Form
Membership rates are $24 per year for students and educators, and $36 per year for non-students (no $19.95 per month charges here!). If you are requesting student/educator rates, please enclose proof of your student/educator status (photocopy of ID, registration form, etc.)
Please enclose check or money order payable to Capitol Macintosh. We are only able to process credit card payments using PayPal from our web site.
| Name |
_____________________________________________ |
| Address |
_____________________________________________ |
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_____________________________________________ |
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City __________________ St ____ Zip_____________ |
| Hm Phone |
(______) ______-________ |
| Wk Phone |
(______) ______-________ |
| 3rd Phone |
(______) ______-________ |
| Email |
_____________________________________________ |
| Birth Month/Day |
_____________________________________________ |
| Referred by |
_____________________________________________ |
| How did you learn about us? |
_____________________________________________ |
____ New Member
____ Gift Membership
____ Membership Renewal
____ Change of Address
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