ACGNJ MEMBERSHIP APPLICATION Amateur Computer Group of New Jersey PO Box 319 South Bound Brook, NJ 08880 [ ] New Member Dues are $14.00 [ ] Renewal Foreign air mail 27.00 Please make checks payable to ACG-NJ First name:__________________ Last name: _______________________ Mailing Address: ________________________________________________ City: ___________________ State: _____ Zip: ______ Country: _____ Business phone: (___) ___-____ Home phone: (___)___-____ [ ] Do not list me in the Membership Directory [ ] Electronic Engineer [ ] Chemical Engineer [ ] Programmer [ ] Student [ ] Electronic Tech [ ] DP Manager [ ] Systems Analyst [ ] Consultant [ ] Teacher [ ] Other, specify ____________________________________________ Who is your employer:__________________________________________ PART II: What topics would you like covered at club meetings: Would you like to speak at a club meeting? [ ] yes [ ] no Topic(s): Can you help the club? [ ] general [ ] newsletter [ ] festival [ ] meetings [ ] user group What can you do? PART III central processing unit 8080 Z80 6800/09 6502 Misc [ ] Imsai [ ] TRS-80___ [ ] SWTP 6800 [ ] Apple_____ [ ] 1802 ____ [ ] Altair [ ] TDL/Xitan [ ] SWTP 6809 [ ] Kim-1 [ ] TI [ ] Sol [ ] HB [ ] TRS-80 [ ] Comm _____ [ ] 8085 [ ] HB [ ] Cromenco __ [ ] HB [ ] HB [ ] 8086/8088 [ ] Health [ ] Sorcerer [ ] Mot EK [ ] OSI [ ] IBM/PC [ ] Polym [ ] Ithica Inter [ ] Heath [ ] AIM [ ] Dec_______ [ ] other [ ] Timex ___ [ ] other [ ] other [ ] 68000_____ [ ] Osborne [ ] Z8000_____ ---------- [ ] Kaypro ______________ ____________ [ ] Fortune [ ] Godbout [ ] Other [ ] Televideo [ ] Sony _____________ [ ] Epson ____ [ ] other ______________ Peripherals Printer CRT Term Disk Misc [ ] TTY Mod:________ [ ] ADM _______ 5" 8" [ ] Modem [ ] Selectric [ ] Hazel _____ [ ] [ ] Tarbell [ ] Music Syn [ ] Diablo [ ] SWTP [ ] [ ] North * [ ] DAC [ ] TI Mod:_________ [ ] Heath [ ] [ ] TRS-80 [ ] ADC [ ] Dec Mod:________ [ ] Soroc [ ] [ ] Apple [ ] Prom Burner [ ] Centronix Mod:__ [ ] HB [ ] [ ] SWTP [ ] Voice out [ ] Heath [ ] Televideo [ ] [ ] Micropolis [ ] Voice in [ ] IDS Mod:_____ [ ] other [ ] [ ] SD sales [ ] Dazzler [ ] Epson Mod:_____ [ ] [ ] other [ ] other [ ] TRS Mod: _____ ------------- [ ] Okidata Mod:___ ------------------- ______________ [ ] other [ ] Hard disk __________________ -------------------- DOS: ___________________________ Cassette type: ______________________________ Ram Size: ____________________ Video Board (specify) _______________________ Other Equip: _________________ ___________________ What do you plan to buy? ________________________________ Applications: [ ] Software development [ ] Hardware development [ ] Word processing [ ] Process control [ ] Education [ ] Business [ ] Hobby [ ] Graphics [ ] Ham radio [ ] Music [ ] Games [ ] Scientific [ ] other: Comments: