Application form for Individual Membership
usenix
usenix
Thu Apr 29 10:48:20 AEST 1982
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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