Please fill this out and return to:
		Jack Eaton
		PO Box 1342
		Jensen Beach, FL 34957

First Name:
Last Name:
Street Address:
City:				 State:       		 Zip:                                      
Phone Number:
E-mail Address:
What is your age?
Male     		Female
 
What are Your Interests?
Star Trek			Science Fiction/Fantasy Novels 
Comic Books		Gaming/Role Playing
Collectables
Other-please specify







Are you currently a member of Starfleet International?: 
	
Have you ever been in another Starfleet International Chapter?:
	

Chapter Name and some of your activities/duties






	
Have you ever been in another Star Trek/Science Fiction Organization?
	
Things you might like to do as a member of the TRIDENT.





DUES:

Individual		$20
Family		$15
Corresponding	$10