North American INGRES Users Association  Membership Application

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A. REGISTRATION INFORMATION
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Last Name _______________________________ 

First Name ______________________________  Middle Initial  ______

Job Title ______________________________________________________________________

Organization Name __________________________________________________________

Address ____________________________________________________________

City ___________________________ State/Province ____________ 

Zip/Postal Code ________ 

Country  _______________

Area Code ______________Phone# _____________ Ext. _________ 

E-mail Address ___________________________________________________________
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 Please return application to:	info@naiua.org