Your personal information will not be sold or used for non-club purposes. Please make your selections carefully and double/triple check spellings of pertinent information (ie: name, address, e-mail, etc.). Also, please be sure to read the information thoroughly at the end of this form.
Your E-mail Address:
Your real (first and last) name:
Your Mailing Street Address:
Your City: State: ZIP/Postal Code:
Have you already paid for this membership? (Reminds us to credit your account) Yes No
Type of Membership: New Reinstatement Renewing Couple/Family Member Gift
How was (or will) this membership be paid for? Check/Money Sent by mail PayPal
Your nickname or fannish name:
Your birthday (optional):
Your Country:
Your Occupation:
Your Telephone number:
Do you want to be added to the Yahoo mail list? Yes No
Please list additional information below, including additional names for joint or family memberships. Make sure to include an extra $4 in dues payment for each additional member of the same household.:
Check all that you would like listed in the Membership Roster which is printed in The Fan and The e-Fan periodically. (Selecting any of the first three options automatically includes your name.):
How do you prefer to recieve your subscription to the N3F zine, The Fan? E-mail in PDF form Printed and mailed to my home
How long have you been interested in Science Fiction and Fantasy?: How long have you been involved in Fandom?: List any other clubs you are or have been a member of: List any conventions you've attended: What Prozines and Fanzines do you read if any?: What is your favorite type of SF/F?: Who are your favorite SF/F Authors: Are you interested in online activities? If yes, what type?:
Which (if any) of the following would you be willing to help the Club with?
Name of Sponsoring Member (if any):