Highlight and Print and complete the form below.  Mail to:

TAMPA BAY COMPUTER SOCIETY

1510 BARRY STREET

CLEARWATER, FLORIDA 33756-4427

MEMBERSHIP APPLICATION - PLEASE PRINT CLEARLY

DATE_________ DUES: $40.00 per year   NEW___ RENEWAL___ #_____

Last Name _______________________ First Name___________________

Street Address____________________ Apt#___ or P.O. Box___________

City_____________________________ State____________ Zip________

Associate member______________________________________ Add $10

Home Phone (   ) _________________ Work Phone(   ) _______________

Cell Phone (     ) _________________ e-mail _______________________

Name of Sponsor_______________________________________________

Member Signature______________________________________________

How did you hear about us? ______________________________________