Membership Form

Date

Name (surname first)
Address (current and permanent)
Phone number (home, work, and fax)
E-mail address
Website
Birth Date
Sex

Occupation
Place of work or school (including address)
Educational background

List details for those of the following which apply (identify by number)

1. Languages (a. speak, b. read, c. write; evaluate each on a scale of fluent, functional, marginal, decipher with translating dictionary). Also indicate those in which you can reasonably secure help in translating
2. Access (e.g., in libraries) to microfilm or other copies of newspapers since 1975 (list; give dates; indicate if indexed)
3. Access to standard indexes (Lexis, Nexis, PsychNet, ERIC, Sociological Abstracts, Psychological Abstracts, etc.)
4. Member of local game club (name, where meets, indicate if officer)
5. Role-playing games played (indicate if as referee)
6. Game convention experience (indicate if refereed, led seminar [indicate subject], convention administration, etc.)
7. Hobbies, extra-curricular activities, and special interests (whether involving RPG or not)
8. Useful job skills (lawyer, printer, police, writer, public relations, etc.)
   Include jobs held in past and those of close relatives and associates (specify areas of expertise) who could help with research and translations.
9. In-service training applicable to RPG (such as "cult awareness seminars")
10. Have electric typewriter (make and list of fonts)
11. Have computer (type, compatibility, fonts, modem, laser printer, etc.)
12. Have copier (type, zoom?, sizes of paper handled)
13. Experience in civil liberties organizations (which and when, capacity)
14. Anything in background that may cause a problem for CAR-PGa (criminal record, school expulsion, etc.)
    This will not exclude you from membership, we just want to avoid being ambushed by it.
15. How did you find out about CAR-PGa?
16. Anything we left out that might be useful