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#                                                                              #
#                Unix Hobbyists' Administrators' & Coders' Club                #
#                           Membership Application                             #
#                                                                              ##  Instructions: Please print and fill out this form. Enclose form along with  #
#               a check for the professional membership fee of $40 (or $15 if  #
#               you are an enrolled high school or college student). Mail to:  #
#                                                                              #
#               UHACC                                                          #
#               P.O. Box 6376                                                  #
#               Bloomington, Illinois                                          #
#               61702-6376                                                     #
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# Date: __________________                                                     #
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# Name: _____________________________________________________________          #
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# Address: _____________________________________________________________       #
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# Age: ___________  e-mail:  _____________________________                     #
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# Phone:  __________________                                                   #
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# Desired username: __________________@uhacc.org                               #
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# Experience: (circle any or all that apply)                                   #
#  [shell coding] [C programming] [php] [admin] [desktop] [web design]         #
#  [beginner] [documentation] [clustering] [open source fan]                   #
#  [machine building] [kernel modding] [electronics]                           #
#  [other ____________________________________________ ]                       #
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# Unix/Unix-like Used: (circle any or all that apply)                          #
#  [Linux] [Solaris] [OpenBSD] [FreeBSD] [NetBSD] [MacOSX] [AIX] [HP-UX]       #
#  [IRIX] [Sun OS] [DGUX] [SCO] [Xenix] [Tru64] [None]                         #
#  [Other(s) _________________________________________ ]                       #
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#    If [Linux] circled above, flavors used/preferred:                         #
#     [Red Hat] [SuSE] [Slackware] [Debian] [Gentoo] [Mandrake] [Knoppix]      #
#     [Ubuntu] [YellowDog] [Other ____________________________________ ]       #
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# How many talking chickens do you own? ________________                       #
#    Do any of them play the oboe? [Y] [N]                                     #
#                                                                              #
# Want some rye? ('Course you do!) [Y]                                         #
#                                                                              #
# Any other geeky/interesting Hobbies outside                                  #
# Unix (ie: ham radio, anime, sci-fi, droid design, nuclear physics,           #
# electronics, rocketry, mindstorms, chemistry etc)? [Y] [N]                   #
#    If [Y]es, List: _____________________________________________________     #
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#    _____________________________________________________________________     #
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# Signed (X)______________________________________________________________     #
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# Note: UHACC will not disclose any of the information you submit to any       #
# outside party for any reason, save the authorities banging on our door with  #
# a subpeona or other such legal mandate.                                      #
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# ~~~~~~~~~~~~~~~~~~~ UHACC admin use only below this line ~~~~~~~~~~~~~~~~~~~ #
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# Taken by: ________________________________________  Date:  ________________  #
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# Approved by:  ________________________________________                       #
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# OK: Shell Mail Web Forum Domain Other _____________________________________  #
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# $____________ Dues/fees paid   Date: _________________                       #
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# Signed: ______________________________________________                       #
# (valid only if signed by UHACC Pres, VP or Secretary                         #
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