Apopuli.164
net.usenix
utzoo!decvax!ucbvax!G:usenix
Thu Apr 29 10:48:20 1982
Application form for Individual Membership





                    1982 Application for New Membership
                             USENIX Association
                      Individual or Public Membership


[  ] Individual ($12, Institution has Source License)
    Institutional Affiliation: ______________________________________________
    Nature of Affiliation: __________________________________________________


[  ] Individual ($12, Institution has Binary License Only)
    Institutional Affiliation: ______________________________________________
    Nature of Affiliation: __________________________________________________


[  ] Public ($12, Not covered by Non-Disclosure)


Mailing Address (Individual Members must use institution address):
Name: ________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Phone: _______________________________________________________________________



[  ] Overseas airmail, add $5.00


[  ] Invoice required, add $3.00 bookkeeping charge

[  ] Receipt required, add $3.00 bookkeeping charge


Check enclosed: $__________


Return completed form to:

                             USENIX Association
                                   Box 8
                         The Rockefeller University
                              1230 York Avenue
                             New York, NY 10021


(For Institutional Membership or membership renewal contact the Association
offices at the address above or at 212-570-8934.)





                                 April 1982





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