Name and Address
----------------
Name: ......................................................................
Address: ...................................................................
...................................................................
...................................................................
E-Mail Address: ............................................................
Home Phone: ...........................Work Phone: .........................
Employer:...................................................................
Title:...................................................................
[ ] Tick here if you want your name EXCLUDED from membership directory and
mailing list offered to SIPA approved users.
[ ] I want to apply for an individual membership. A check for $20.00
is enclosed.
[ ] I want to apply for a joint membership. A check for $30.00 is
enclosed, along with the membership form for my spouse.
My spouse's name is .......................
Signature: ................. Date: ................
Please make checks payable to SIPA and mail to address below:
SIPA
P.O. Box 3533
Santa Clara CA 95055