QCMUG

Quad Cities Macintosh Users Group
Membership Form

Print the form out and then complete the Membership Information Form.

Please submit your dues ($24, payable to “QCMUG”) at the next monthly meeting, or mail them directly to the treasurer at the address below with this form filled out.

QCMUG Treasurer
4023 Lillie Ave. #504
Davenport, IA 52806

First Name: ___________________________________________________________

Last Name: ___________________________________________________________

Address: _____________________________________________________________

City:

State: _________________          Zip Code: ____________________

Phone: ______________________________    ❑ Home  ❑ Cell   ❑ Business

Email address: ________________________________________________________

If paying for family membership please list other members of your family.

1. ___________________________________    Emails: ________________________

2. ___________________________________    Emails: ________________________

3. ___________________________________    Emails: ________________________

4. ___________________________________    Emails: ________________________

If this is a business membership please list the business name & address.

Business name: ________________________________________________________

Address: ______________________________________________________________

Paid by:

❑ Cash: __________________

❑ Check #: ____________________________              Date: _____________________