NORTH WEST PACKET USER GROUP -- MEMBERSHIP APPLICATION FORM
       -----------------------------------------------------------

   Please print out this application form below and post it together with a
   cheque for £7.50 made payable to the  'North West Packet User Group'
   to:-

        Mrs Win Bateman, (Treasurer),
        Ingleside,
        Waterloo,
        Whixall,
        Whitchurch Salop.  SY13 2PX

 -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -

 CALLSIGN> ............................

 SURNAME> .................... FORENAME>  ...................................

 ADDRESS> ...................................................................

 POST-CODE> ...........................

 HOME PHONE (inc std)> ......................   YOUR LOCAL MAILBOX> .........

 OTHER RADIO CLUB MEMBERSHIPS> ..............................................

 TNC DETAILS> ...............  COMPUTER/TERMINAL DETAILS> ...................

 BANDS ACTIVE ON (please circle)>  hf  10m  6m  4m  2m  70cm  23cm  higher

 Please fill in all the details to help us obtain an accurate picture of
 packet activity in the North West and thus plan an effective network for
 the future.

 Please make cheques payable to:-   NORTH WEST PACKET USER GROUP      (NWPUG)

 SUBSCRIPTION  ENCLOSED  7.50
                                   (If you would like to make an extra
 DONATION                           donation to further help the Group's
                       -------      activities, please include it here)
               TOTAL
                       -------

 SIGNATURE >.................................. DATE >....................

 I confirm that the details given above are correct and that I have no
 objection to this and subsequent information being stored on a computer.

 N.B.  It is a condition of membership that you agree to these and subsequent
 details being stored on a computer.   This information will not be made
 available to anyone outside of this Group unless prior permission has been
 obtained from you.   Your signature above acts as acceptance of these terms.

 This statement complies with the provisions of the Data Protection Act and
 accordingly we regret that unsigned applications cannot be accepted.