PATACS Membership Application

Potomac Area Technology and Computer Society

An IRS recognized, 501(c)(3) Non-profit, Educational Organization
PATACS Family Membership Application

PATACS Membership, 4628 Valerie Ct., Annandale, VA 22003-3940
All * Entries are required for Submission (ver 21-3)
Street Address is required for mailed hardcopy Newsletters
Membership Application *

New Member Renewal Donation Only Admin Change Gift Member
First Name *
MI
Middle Initial
Last Name *
Preferred Name
Street Address
Required for mailed hard copy Newsletter
City
State
Zip Code
12345-6789
Primary Phone #
Secondary Phone #
Primary Email *
Example@gmail.com
Secondary Email
Example@gmail.com
Additional Family Members (up to 3) - Will receive a membership badge and email link to Newsletters. A membership using the Family Member option is entitled to only one Vote in elections and one print edition newsletter subscription.

Additional Family Member (FM) options
1st FM Email
Example@gmail.com
1st FM Badge Name
2nd FM Email
Example@gmail.com
2nd FM Badge Name
3rd FM Email
Example@gmail.com
3rd FM Badge Name
PATACS publishes a membership roster. This enables members to contact each other for assistance with hardware and software problems, help with purchasing decisions, and establish special interest groups. You will be included unless you initial below to OPT out:
No to Roster
Paying Member - must initial to OPT out
All members receive a download link via email to the PATACS Posts PDF color edition of our monthly newsletter. Members in good standing are eligible to receive one black and white printed edition of the newsletter via USPS. To OPT IN to receive the printed edition of the newsletter, please check yes in the Hard-Copy option box below.
Hard-Copy

No Yes
New Member? Where did you hear about PATACS? Internet? Newspaper? OLLI?
Member name (needed to award recruiting bonus)? Add to box below.
Gift Membership? Include YOUR email address in the Application Primary Email box and include the NEW member's email address in the Application Secondary Email box above. If a Member, put your name in comment box to receive recruiting bonus.
Add any other comment in box below.
Comments
..
Payment Option *

No Payment By Check By Bill Pay By PayPal By Credit/Debit Card
Dues Selection

$30 - 1 Year $60 - 2 Years $90 - 3 Years $120 - 4 Years $150 - 5 Years
Donation
$ example = 10
Payment Type
Read Only
Dues
Read Only
Payment by PayPal or Debit/Credit Card requires using the Pay Dues button below the application form to pay your membership dues + donations to PATACS
All * Entries are required for Submission
==Mailing Address for Checks==
PATACS Membership
4628 Valerie Ct
Annandale, VA 22003-3940

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Potomac Area Technology and Computer Society

PATACS Family Membership Application