Please print this form out using your browser's Print command, fill it out, and send it to the indicated address, with payment.

The ACCESS Special Interest Group
of New York Personal Computer (NYPC)
Joint Membership Application

__________________________________________________________________________________
          Schedule of Charges                |   Amount Included in Check
_____________________________________________|____________________________________
NYPC Membership ($35 for 12 months)          |
                                             |
_____ New Member                             |
                                             |
_____ Extend Current Membership by 12 months |
_____________________________________________|____________________________________
Access SIG Membership ($5 for 12 months)     |  
                                             |
_____ New Member                             |
                                             |
_____ Extend Current Membership by 12 months |
_____________________________________________|____________________________________
                                             |
                      Total Check Amount     |
_____________________________________________|____________________________________

Make Check payable to NYPC. Mail with this application to:
    NYPC, c/o Claire Chase, 60 West 13th Street, New York, NY 10011

        Name:_____________________________________________________________________

Home Address:_____________________________________________________________________ 

        City:_____________________State:_____ ZIP:___________Tel:_________________

Company Name:_____________________________________________________________________

     Address:_____________________________________________________________________

        City:_____________________State:______ZIP:___________Tel:_________________

Email Address:____________________________________ Type:______________

 Send Mail To: (Check one)    Company:____      Home: ____
______________________________________________________________________________

---