MEMBERSHIP APPLICATION FOR SENIORNET PAPAKURA INC:

I / WE wish to apply for membership of SeniorNet Papakura Inc, and confirm my eligibility by being 55+ years of age. Enclosed find my cash / cheque for $30 single / $50 double. (Membership renewal on 1^st March each year.)

Mr �        Mrs �       Ms �       Dr �

First Name/s__________________________________________________________

Preferred First name/s for membership badge/s_________________________

Surname____________________________________________________

Ethnicity_________________Age 50 - 60______60+________

Address_____________________________________________________

_____________________________________Post Code______________

Phone_____________________ E-mail_____________________________

Have you previously been a member of SeniorNet Papakura? Yes / No

How did you find out about us?__________________________________

Are you a past or current member of another SeniorNet group? Y / N

If Yes, where / when?_______________ Do you have a computer? Y / N

At our club we currently use Windows XP and Vista with associated software.

Please tick which Operating System you use at home.

WINDOWS XP � WINDOWS VISTA � WINDOWS 7 � APPLE - MAC �

Which programme do you use for WORD PROCESSING? Please indicate the version if known (i.e. Word 2007). Your version is found by opening WORD then selecting from the menu bar HELP then ABOUT.

� MS WORKS ______ � MS WORD_______ � MS WORKS SUITE__________

� MS OFFICE _______ � Open Office______________________

SIGNATURE___________________________ DATE_____________________

This page is for your info: and record only.

Please make your cheques payable to SENIORNET PAPAKURA INC: and cross it A/c Payee Only.

Record your Cheque No: here___________________Date Sent________________

Attach your remittance to the FRONT PAGE ONLY and Post this application to:

SeniorNet Papakura Inc

PO BOX 72 427

PAPAKURA 2244

Tel: Diane O'Sullivan (09) 570 2751

or the Learning Centre on (09) 296 7263

for further information.

More information can be obtained by accessing our web site at www.seniornetpapakura.org.nz.

This includes our latest Newsletter and Bulletin Board.