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Please fill in this form, print out the page and mail it to:
Jack Fisher, treasurer, SCUM, 1137 Elm Street San Carlos, CA 94070

Note: Please make out your check to "City of San Carlos" in the amount of $15.00
(this pays for up to two members of your family).
Questions? Call Jack Fisher at 650-591-4229 or Joyce Friedlander at 650-572-0480

First Name:    Last Name:

Spouse/Partner First Name:     Last :

What first name would you like on your name badge (and spouse/partner) ?

Street Address:

City:     State:     ZIP:

Email Address:

Daytime Phone:     Evening Phone:

Model of Macintosh You Use:

Primary Operating System: Mac OS X    Mac OS 9       Other:

Internet Access: Cable Modem   DSL     Dial-Up     I don't have access

What are you special computer interests?

How did you hear about SCUM?

Anything else we should know about you?

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