Usenix Association Application for Institutional Membership for Calendar Year 1983 Please type or print [ ] New [ ] Renewal Name of Institution Dept / Campus / Plant site: Full name of institution holding the license if different from above: The annual dues depend on the type of license held; check one: [ ] $100: Educational license [ ] $300: AT&T or Subsidiary (non-voting membership) [ ] $300: Other license For all licenses owned indicate type by S (for source) or B (for binary) [ ] Mini-UNIX [ ] Version 6 [ ] PWB/UNIX [ ] Version 7 [ ] 32V [ ] System III [ ] System V [ ] UNIX/TSS [ ] UNIX/UNIVAC [ ] UCB2.xBSD [ ] UCB4.xBSD [ ] Other: Name and address of the Institutional Name and address of the person to receive delegate. This person will receive all offical the newsletter and software distributions, correspondence and the renewal notice for next year. Phone: ( ) Phone: ( ) Network address: Network address: [ ] Check enclosed: $ [ ] Invoice required Authorized Signature: Date: Please return the completed form to the address below with copies of the following pages of the license for your plant site or campus: the signature page and the pages that show the version of UNIX you are licensed for, whether it is for source or binary, the name of the institution owning the license, and the type, serial number, and location of the CPU(s). If you have more than one license please send the above information for each license. USENIX Association P.O. Box 7 El Cerrito, CA 94530 r O o at This form must accompany your purchase order or payment Mem#: Check#:
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