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Application For
Residence Status on

Starbase OR.CA


A Southern Oregon
and Northern California
Star Trek Fan Club





For printable application click here



Date:

Name:

Email adress required for on-line applications

E-Mail:

Adress Line 1:

Adress Line 2:

City: State:

Postal/Zip Code: Country:

Home Phone:Message Phone

Please answer the following questions

How often do you watch Star Trek?:

Which Star Trek Shows do you watch?
Original Star Trek (Kirk and Spock)
Star Trek:TNG (Picard and Ryker)
Star Trek:DS9 (Sisko and Kira)
Star Trek:Voyager (Janeway and Chakotay)

How much time per month would you be willing to spend on club acctivities:

What days of the week are best for you for club meetings?
Mark all that aplly.
Monday
Tuesday
Wensday
Thursday
Friday
Saturday
Sunday

What time period is best for you?

Your membership will be activated as soon as your dues are received. (See below)






Additional Information

Membership meetings will be held

Quarterly

Membership dues are $5.00 per month or $30.00 per year.

The Starbase OR.CA newsletter is available seperately for $12.50 per year for U.S. Residents and $17.50 per year for anyone outside of the U.S.

Club information will be posted in regional newspapers, the I.D.I.C (club newsletter), and on this web site.

Make check or money order payable to:

For club dues/membership (includes newsletter):

Paul Walker Jr
P.O. Box 131
Rogue River, OR 97537
USA


For newsletter only:

Ron Fitch Jr
P.O. Box 553
Gold Hill, OR 97525
USA


For a sample newsletter please include your snail mail adress in a E-mail to Ron Fitch.

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