Membership Application
Cajun Clickers Computer Club

Please print the application form and mail it with payment to the address on the following page.

Bold Indicates Required Fields

Application Type:

 New Member
Membership Renewal
Change of Address
Membership Number:
(only needed if renewal or change of address)
         
Name:
Address:
City:
State:
ZipCode:   - 
E-Mail:
            
Phone (Home):
Phone (Work):
       
Where did you hear
 about the Cajun Clicker:
Sponsor (If Applicable):
      
Additional Family Members 
to be included on membership:
     

Payment Type:

 Cash / Check / Money Order
Visa / Mastercard
      

Length of
Membership / Renewal:

 1 Year - $45
2 Years - $80
3 Years - $120