Aztec Member Application Form


Please PRINT the information you supplied when you registered online:


_____________________________________________________________________


UserID:    |_|_|_|_|_|_|_|_|      (case-sensitive, max. 8 characters)

Address:   _________________________________  City: _________________

State:     |_|_|  ZIP: |_|_|_|_|_|-|_|_|_|_|  Country: ______________

Phone#:    |_|_|_|-|_|_|_|-|_|_|_|_|     (10 digit; include area code)



I agree: __________________   Date: __/__/_____ (please sign and date)


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Mail:  AzTeC Computing        -OR-   Scan your SIGNED registration form
       PO Box 15844                  Email as .JPEG file attachment to:
       Phoenix, AZ 85060-5844        register@aztecfreenet.org

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