THE SOUTHERN CALIFORNIA OS/2 USER GROUP

                             Membership Application

          ( )  New Member
          ( )  Renewal
          ( )  Information Change

          Please print clearly.  
          Required information:

             Name: ____________________________________ 

             Email: ___________________________________  

          Additional useful - but not required - information:

             Phone: ___________________
          
             Mailing Address: ________________________________________

             City: ______________________   State: _____   Zip: ___________


          ( )  I do NOT want my name to be released to others for mailing 
               lists
          ( )  I do NOT want my phone number to be included in the SCOUG
               Phone Book


          Signature: ____________________________   Date: __________________


                        Mail this form to:
                                 OS/2 User Group
                          Attention: Membership Secretary
                                  P.O. Box 26904
                               Santa Ana, CA. 92799

                        Email questions to:
                                 membership@scoug.com