*reguired fields	Print and mail this form with your check.
* First Name	* Last Name
* Organization
*Title
*Address 1
Address 2
*City	*State
*Zip Code	*Country
*Phone	Fax
*Email
RATES
Charter Trial-6 months	$25.00
Students-1 year	$25.00
Business Individual-1 year	$50.00
Corporate (unlimited individuals) 1 year	$150.00
Payment: Please mail this form and check only to PNWCMUG, 2100 NW 22nd Ave. Ste 200, Portland OR 97210
Privacy Statement: CMUG does not allow access to your information by any outside source except specific to CMUG related events or notifications. If at any time you do not want to receive these notifications email us back at hatmaker@chromix.com.