RASCAL
Membership Application

Please Type or Print All Personal Data.
(Your name will appear on your identification badge.)

DATE: 29 July 2010

NAME:

If this is a Couple Membership, will each one of you please fill out your own form.

ADDRESS:

CITY: STATE: ZIP:

EMAIL: PHONE:

Have you been a RASCAL in the past?    Yes     No

How did you learn about RASCAL? (media, friend, member, brochure)

Level of Computer Knowledge/Skill:       None       Beginner       Some Experience or Higher

Operating System:       Don't Know       Windows 98       Windows XP       Vista       Other

Would you like to volunteer for RASCAL? (check any that interest you)
 

Telephone

Data Entry

Assist with Web Pages

Hold a Club Office

Plan Social Activities

Teach a Class

Database Programming

Help with Newsletter

Annual Dues: YEARLY: lndividual - $15; Couple - $20;
LIFETIME: Individual - $100; Couple - $150.
An individual must be 55 or older to join. For Couples, one person must be 55 or older, and both must have the same last name, address, email and phone number.

Please make checks payable to RASCAL. Bring the application to a meeting, or mail it to
RASCAL, 214 SW 4th Street, Grants Pass, OR  97526.
A RASCAL member will soon be contacting you to welcome you to our club and to answer any questions you may have.

Please fill out the Members Profile on the next page