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Greater Atlanta Chapter
IBM Quarter Century Club
Membership Application

Annual membership dues are $10.00. Please complete the application online and print it (use File>Print or Ctrl+P) for mailing. Mail the printed application to the address below with your check for $10.00 made out to Atlanta Chapter IBM QCC:

IBM Quarter Century Club Atlanta
C/O Peggy Rogers

1648 Musket Ridge NW
Atlanta, GA 30327

IBM Quarter Century Club Atlanta Membership Application

Last Name:     Suffix:   Initials:   

First Name:   Nick Name:     Spouse Name:

IBM Serial #: Date Inducted into QCC (mm/dd/yyyy): / /


City:       State:    Zip:  

Phone:                 ()   

E-Mail Address:

Additional comments:  

Referred  by:                 

Print this page (use File>Print or Ctrl+P) for mailing when you are finished.

Last updated April 22, 2018