New Member Application Form

Name:    E.g., Jane Doe, Col. John Drake III, M.D., etc.

Home Street Address:    E.g., 1825 Brdavs Drive

City:    E.g., Roseville      State:   E.g., CA        Zip:     E.g., 95747 or 95747-5807

Female  Male                           HP Retired (Gold Badge) or Agilent Retired (Silver Badge)

If you are not an HP employee or retiree, fill in
HP Spouse's Name:    First and last.  (HP Spouse must be an hpGA member.)

Telephone:    E.g., 5-1212, 7851212, etc.         Bldg:    E.g., R3L, R4, Home, Ret, Non, etc.

    Mailstop:    E.g., 5559, etc.  (Retirees, working at home and non-HP use 1111.)

       E-mail: 
E.g.,  joe_golfer@hp.com

Has applicant been an NCGA Member in the last two years?           Yes  No
                                           Or, a Member of another GHIN club?           Yes  No

If the answer to either of the preceding two questions is yes, please enter NCGA/GHIN #, and, if applicable,
names of other NCGA/or GHIN clubs applicant is a member of:

              GHIN#:    Seven digits, with or without hyphen.

Member Clubs:    E.g., Woodcreek, Sunset Whitney, etc.

Comments;