Capitol Macintosh Membership Application

Name
 first
 mi
 last
Company
Address
 line 1

 line 2

 city
 state
 zip code
Phone
 home

 work

 other/mobile/fax
Email
Membership Type New Regular ($36)
Renewal Regular ($36)
Gift Regular ($36)
 New Educator/Student ($24)
Renewal Educator/Student ($24)
Gift Educator/Student ($24)
Payment Type Check (by mail)
 PayPal
Referred to CapMac by
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