Member Information Required Fields Optional Fields Family and Dependent Memberships only
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| Last Name |
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| First Name |
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| Middle Initial |
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| Nickname (None) |
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| ListServer email |
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| Landline |
Cell
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| Mailing Address |
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| Mailing City |
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| Mailing State |
ZIP
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Contact Choices
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| List Server (SMUGAnnounce) |
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| Mailing List |
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Membership Status
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| Member ID # |
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| Date Joined Club |
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| Membership Type |
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Individual, Family*, Student, Dependent*, Life |
| *Family Group(Family Name) |
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| *Size of Group(Number) |
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| *Group Order(Number Rank) |
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| *Salutation |
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example: Hacker, Apple, Surfer and Gamer MacGeek |
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Payment Record
Individual ($24), Family ($36), Student ($12) Dependent ($0)
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| Payment Amount |
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| Payment Date |
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| Method Paid |
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| Delivered to |
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| Delivery Method |
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| Paid by |
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Other Contact Info
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| Home Address |
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| Home City |
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| Home State |
ZIP
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| Home Phone |
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| Alternate Address |
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| Alternate City |
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| Alternate State |
ZIP
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| Alternate Phone |
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| Alternate email |
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| iChat |
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| Website |
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Work Contact Info
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| Work Address |
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| Work City |
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| Work State |
ZIP
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| Work Phone |
Ext
FAX
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| Work email |
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| Work Website |
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Notes
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SMUG Member Registration