NCPU Membership Form

NCPU Number	(from mailing label, blank for new or unknown)

Application For *

Category *
Name *
Company
Address Line 1 *
Address Line 2
City *
State/Province *
Zip/Postal Code *
Country
Daytime Phone *
FAX Number
Home Phone
Primary Email
Secondary Email
Web Site URL
Newsletter Via *
Do-NOT options for Members and Sponsors only:
Do NOT email NCPU Announcements for meetings and other NCPU news
Do NOT post my name on the NCPU Web Site
Do NOT post my email address on NCPU Web Site
Do NOT post my Web site URL on NCPU Web Site
Do NOT publish my Member data in the NCPU Membership Directory

Description of Business (optional): Hardware Platform(s) (optional): Software Platform(s) (optional):
Comments or Questions (optional): NOTE! If you are sending a check, it must be received within 15 days to validate your entry. We suggest you do not submit your form until after your check is mailed. Please make checks payable to Northern California Pick Users and snail-mail to:

Northern California Pick Users
Att: Donna Wirthman
300 Murchison Drive, Suite 307
Millbrae, CA 94030