First Name:	Last Name:
Address:
City:	State: Zip:
E-Mail Address:
What is you Major?	C.I.S. O.I.S. Business General Studies Undecided Other
Your Student Status?	Full Time (12 Hours or more) Part Time Non-Degree Seeking
Your Interests? (check all that apply):	Windows Applications Programming System Design	Graphics The Web Networking
Comments?:
Dues are $25 per year, paid to National Headquarters