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 a $30 single / $50 double.(Membership renewal on 1^st March each year.)

Mr �        Mrs �       Ms �       Dr �

Surname__________________First Name/s____________________________

Preferred First name/s for membership badge/s_________________________

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 7 and Windows 8 with associated software.

Please tick which Operating System you use at home.

WINDOWS 7_____WINDOWS 8_____APPLE - MAC_____iPAD_________

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

MS WORD_______ MS OFFICE SUITE__________

Open Office Apache _____Libre_____ Kingsoft_____

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: Marsha Jobes on (09) 267 9849

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.