                  ACGNJ MEMBERSHIP APPLICATION
              Amateur Computer Group of New Jersey
                           PO Box 319
                   South Bound Brook, NJ 08880


[ ] New Member                                  Dues are $14.00
[ ] Renewal                             Foreign air mail  27.00
              Please make checks payable to ACG-NJ

First name:__________________  Last name: _______________________

Mailing Address: ________________________________________________

City: ___________________ State: _____ Zip: ______ Country: _____

Business phone: (___) ___-____          Home phone: (___)___-____

[ ] Do not list me in the Membership Directory
[ ] Electronic Engineer   [ ] Chemical Engineer  [ ] Programmer
[ ] Student               [ ] Electronic Tech    [ ] DP Manager
[ ] Systems Analyst       [ ] Consultant         [ ] Teacher
[ ] Other, specify ____________________________________________

Who is your employer:__________________________________________

PART II:
What topics would you like covered at club meetings:


Would you like to speak at a club meeting? [ ] yes [ ] no
Topic(s):

Can you help the club? [ ] general   [ ] newsletter  [ ] festival
[ ] meetings  [ ] user group

What can you do?

PART III
central processing unit
8080         Z80              6800/09          6502             Misc
[ ] Imsai    [ ] TRS-80___    [ ] SWTP 6800    [ ] Apple_____   [ ] 1802 ____
[ ] Altair   [ ] TDL/Xitan    [ ] SWTP 6809    [ ] Kim-1        [ ] TI
[ ] Sol      [ ] HB           [ ] TRS-80       [ ] Comm _____   [ ] 8085
[ ] HB       [ ] Cromenco __  [ ] HB           [ ] HB           [ ] 8086/8088
[ ] Health   [ ] Sorcerer     [ ] Mot EK       [ ] OSI          [ ] IBM/PC
[ ] Polym    [ ] Ithica Inter [ ] Heath        [ ] AIM          [ ] Dec_______
[ ] other    [ ] Timex ___    [ ] other        [ ] other        [ ] 68000_____
             [ ] Osborne                                        [ ] Z8000_____
----------   [ ] Kaypro       ______________   ____________     [ ] Fortune
             [ ] Godbout                                        [ ] Other
             [ ] Televideo
             [ ] Sony                                            _____________
             [ ] Epson ____
             [ ] other
              
             ______________

Peripherals 
Printer               CRT Term          Disk                 Misc
[ ] TTY Mod:________  [ ] ADM _______   5"   8"              [ ] Modem
[ ] Selectric         [ ] Hazel _____   [ ]  [ ] Tarbell     [ ] Music Syn
[ ] Diablo            [ ] SWTP          [ ]  [ ] North *     [ ] DAC
[ ] TI Mod:_________  [ ] Heath         [ ]  [ ] TRS-80      [ ] ADC
[ ] Dec Mod:________  [ ] Soroc         [ ]  [ ] Apple       [ ] Prom Burner
[ ] Centronix Mod:__  [ ] HB            [ ]  [ ] SWTP        [ ] Voice out
[ ] Heath             [ ] Televideo     [ ]  [ ] Micropolis  [ ] Voice in
[ ] IDS Mod:_____     [ ] other         [ ]  [ ] SD sales    [ ] Dazzler
[ ] Epson Mod:_____                     [ ]  [ ] other       [ ] other
[ ] TRS Mod: _____    -------------
[ ] Okidata Mod:___                     -------------------   ______________
[ ] other
                                        [ ] Hard disk __________________
--------------------         
                                        DOS: ___________________________



Cassette type: ______________________________  Ram Size: ____________________

Video Board (specify) _______________________  Other Equip: _________________

___________________ What do you plan to buy? ________________________________

Applications:
[ ] Software development             [ ] Hardware development
[ ] Word processing                  [ ] Process control
[ ] Education                        [ ] Business
[ ] Hobby                            [ ] Graphics
[ ] Ham radio                        [ ] Music
[ ] Games                            [ ] Scientific
[ ] other:             

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