Application form for Individual Membership

[usenix]

                     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