Name: ___________________________________________
Address: ___________________________________________
City/State: ___________________________________________
Zip: ________ Phone: _____________________________
E-mail: ___________________________________________
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Send this form and a check (made out to Charles Kaplan) in the
amount of $5.00 for a one year membership to:
New York Metro Chip Club
Charles Kaplan
11 Calais Court
Rockville Centre, NY 11570