Membership Form



  Please complete this form and send it with Cheque or Money
   Order payable to ‘Minkirri Internet Access’.  Post to ‘9
 Jarvie Street, East Brunswick, Vic 3207.  Current Membership
  is $75 per year for 1 Hour per day, $25 per year for APANA
                          membership.

   You may stay logged onto the computer if there is still a
   vacant incoming line, otherwise you will be automatically
                          logged off.


NAME     
--------------------------------------------------------------------


ADDRESS  
--------------------------------------------------------------------         


--------------------------------------------------------------------
         
PHONE    
------------------------------------

FAX
------------------------------------

Operating System
ie: Windows 95, NT, Windows 3.11, MSDOS, OS/2, Linux


--------------------------------------------------------------------


TYPE OF ACCESS REQUIRED  (SLIP/PPP/TERMINAL)
If  SLIP or PPP access, then you should also become a member
of APANA and fill out the APANA membership form.  There is a
web-membership form which you can fill in on-line, you can get
to it from http://www.apana.org.au     You can just send a
single cheque to us and we will forward any appropriate money
to the committee.

If you are not sure then start off with Terminal and we will
work our way from there.

I require SLIP / PPP / TERMINAL access.   (Cross out any not
applicable)


DECLARATION:

I will be responsible for any or all  programs and data that I
download from the Internet, and will not hold Minkirri
Internet Access liable for the content of documents, programs,
and World Wide Web pages that I may access.


Signed:                                      Date:

        ---------------------------------            -----------------


If under 18 years of age please have your Parent/Guardian sign
their consent below.

Name of Parent/Guardian:

                          --------------------------------------------


Signed:                                      Date:

       -----------------------------------          ------------------