Apopuli.164 net.usenix utzoo!decvax!ucbvax!G:usenix Thu Apr 29 10:48:20 1982 Application form for Individual Membership 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