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The WNY Computer Society Membership Application

Thank you for your interest in joining The WNY Computer Society.

Please complete the form below, being sure to select which type of membership you would like to purchase. If you are unsure of the membership type, please contact a club officer via the information found on the ComSoc Staff page or use the Contact Us page before completing this application.

Please note that your membership is not complete until we have received your payment. You have your choice of submitting payment by credit card or your paypal account via our secure payment page or mailing a check or monery order to:

The WNY Computer Society - ComSoc Membership Committee
3380 Sheridan Drive
PMB 422
Amherst, NY 14226-1439

Make check or money order payable to:   WNY COMSOC

If you select credit card or paypal account, you will automatically be redirected to our secure payment page after verifying the information entered below.

Last Name:
First Name:

Street Address:
City:
State / Zip Code:

/
Daytime phone:
Evening Phone:
Leave the evening phone blank if it is the same as your daytime number.
( ) -   ext.
( ) -   ext.
E-Mail Address:
How did you hear about ComSoc? This Website
Another Club Member
A Computer Show
If you selected "Another Club Member" above, please specify who referred you:
Were you ever a member of ComSoc or BIBMUG in the past? Yes   No
Type of membership to purchase:

An individual/single membership.

Membership for all residents of a specific household. Please enter all names for membership cards in the next form field.

Proof of age (birth certificate, driver’s license, etc.) is required by mail to address listed above. Records will be maintained in the database thereafter.

A copy of tuition bill or class schedule showing full-time status must be submitted by mail to address listed above.

Proof of physical or mental disability that prevents you from obtaining or maintaining full-time employment is required by mail to address listed above.

Any person wishing to join the club and does not live in either the eight counties of Western New York or the Niagara Region of Ontario, but wishes to have club membership and access to member features of our website.

Entitles the purchaser to designate up to 6 people for club membership status.

A one time purchase of a lifetime membership for an individual.

If you selected "Household Membership" above, please specify all names of individuals in your household to receive membership cards.:
Method of payment:
Please Note: If you select paypal or credit card, you will be redirected to a secure page for billing information after confirming your entries in this form.
Online via Paypal Account or Credit Card
Check or Money Order by mail
Comments or questions:
If you have any comments or questions, please enter them here.
Verification Code:
Please type the letters you see in the picture.
Valid characters are: A-H, 1-9, #, $.
Note: The above verification image is used to protect against spam.
Please note: All required fields displayed in bold type.

   

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