QCC Application

Greater Atlanta Chapter
IBM Quarter Century Club
Membership Application

Annual membership dues are $10.00. Please complete the application online and print it (use File>Print or Ctrl+P) for mailing. Mail the printed application to the address below with your check for $10.00 made out to Atlanta Chapter IBM QCC:

Atlanta Chapter IBM QCC
P. O. Box 1193
Woodstock, Ga. 30188

                               2008 IBM Atlanta QCC Membership Application

Last Name:     Suffix: Initials:

First Name: Nick Name:     Spouse Name:

IBM Serial #: Date Inducted into QCC (mm/dd/yyyy): / /

Street:

City:     State:    Zip:

Phone:                 ()

E-Mail Address:

Additional comments:

Referred by:

Print this page (use File>Print or Ctrl+P) for mailing when you are finished.

Last updated February 5, 2008