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\usepackage{csquotes,lmodern,mathptmx}
\usepackage[
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]{hyperref}

\title{Renewal Application}
\author{UK \TeX\ Users Group}
\date{2010}

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\begin{document}
\thispagestyle{empty}

\begin{minipage}{\textwidth}
  \makeatletter
  {\Large \@author}
  
  \smallskip
  
  {\large \@title\ \@date}
  
  \medskip
\end{minipage}

The information you supply will be held in a database and used
for the purposes of managing your UK-TUG membership and the 
affairs of the group (as detailed in the Constitution, see
\url{http://uk.tug.org/about/constitution/}).

If you apply for joint TUG and UK-TUG membership, you agree to 
TUG's data protection policy, (see 
\url{http://tug.org/join.html#privacy}) and to UK-TUG passing 
on your details to TUG. TUG stores and processes your details 
outside Europe.

Members will be sent a free copy of the current DVD \enquote{\TeX\ 
Live 2010}. This allows easy installation of \TeX\ and friends, 
including \LaTeX, on Windows, MacOS X and GNU-Linux.  

Please either complete this form and return it by post to the address
below, or e-mail the equivalent information to 
\url{membership@uk.tug.org}. 

\begin{minipage}{\textwidth}
  \bfseries
  Joseph Wright\\
  UK-TUG Membership Secretary\\
  2, Dowthorpe End\\
  Earls Barton\\
  Northamptonshire\\
  NN6~0NH
\end{minipage}

\medskip

\begin{itemize}
  \item [[~]] Membership of UK-TUG: \emph{no charge} for members
    renewing in 2010.
  \item [[~]] Joint TUG and UK-TUG membership at \pounds 40.
  \item [[~]] Joint TUG and UK-TUG membership at the 
    concessionary\textsuperscript{*} \pounds 25.
\end{itemize} 
\textsuperscript{*}~Concessions: full-time student, state pension. 
Please send relevant photocopy with your application if not seen 
previously by UK-TUG.

Joint members do not receive duplicate printed material or
software from TUG where UK-TUG already supplies it. This saving
allows the additional fee for joint membership to be less than the
standard TUG membership fee.

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  Name: \\[0.2 cm]
  E-mail address:\\[0.2 cm]
  Postal address: \\[1.5 cm]
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\ShowBoxed{%
  \textbf{Payment details}\\[0.25 cm]
  Please make cheques payable to  \enquote{UK TeX Users Group} 
  or \enquote{UK-TUG}.\\
  \begin{itemize}
    \item Membership fees \pounds
    \item \emph{Optional} donation to UK-TUG \pounds
    \item \emph{Optional} donation to \LaTeX3 Fund \pounds
  \end{itemize}
}

\ShowBoxed{%
  \textbf{\emph{Optional}: UK-TUG Membership Directory} \\[0.25 cm]
  
  I wish to appear in the UK-TUG Membership Directory. I understand
  that my name and e-mail address will be supplied only to other
  members also in the Directory. I will not distribute the Directory
  or any details therein any further, nor use them inappropriately.
  
  \bigskip

  \textbf{Signed: \hspace{6cm} Date:}
}

\end{document}
