Membership in Electronic Frontier Canada
----------------------------------------


To apply for membership in Electronic Frontier Canada, fill in
the following form and send it to us, preferably by email.
Then mail your donation to:

   Electronic Frontier Canada
   attn: Dr. Jeffrey Shallit, Treasurer
   20 Richmond Ave.
   Kitchener, Ontario  N2G 1Y9
   Canada

   email:  efc@efc.ca


=====  C U T   H E R E  ========================================8<

  I wish to become a member of Electronic Frontier Canada.
  I am sending:

  ___ Regular membership -- $40
  ___ Student membership -- $20    <---includes Senior Citizens

  I wish to make an additional donation in the amount of $_______
  to further support the activities of EFC and to broaden
  participation in the organization.

  I realize this donation is not tax-deductible.

  Please make your cheque or money order payable to:
  "Electronic Frontier Canada, Inc."

  This donation will be used to pay for communications costs,
  legal fees, the organization of special symposia, and other costs
  related to the aims of EFC.


YOUR CONTACT INFORMATION:
-------------------------

Name:
Organization:
Address:
E-mail address:
Phone:
Fax:

I have access to these Internet resources (check all that apply):
  [ ] email
  [ ] usenet news
  [ ] ftp
  [ ] gopher
  [ ] www/mosaic
  [ ] pgp





YOUR BACKGROUND (optional):
---------------------------
 (If you don't mind, we'd like to know a bit more about you.
  If you'd rather not answer, just leave it blank.)

Sex:
Date of Birth:
Education:
Occupation:

I use the following kinds of computers:
  [ ] Mac
  [ ] PC
  [ ] Unix workstation
  [ ] other

I have used computers for ___ years.

I have used the Internet (or something like Compuserve) for ___ years.

I have the following expertise I'd like EFC to know about:








PRIVACY POLICY
--------------

EFC may occasionally share our mailing list with other organizations
promoting similar goals.  However, we respect an individual's right to
privacy and will not distribute your name without explicit permission.

  ___  I grant permission for EFC to distribute my name and contact
       information to organizations sharing similar goals.


------------------------------------------------[last changed: 21mar95]---
This form came from the EFC gopher, accessible on the Internet using:
   gopher -p "1/org/efc" insight.mcmaster.ca
If you found it elsewhere, please tell us where so we see how far it goes.
==========================================================================

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