PERSONNEL FILE (CONFIDENTIAL)

Date of Resignation:                                                                                                                 .

Earther Name:                                                                                                                          .

Address:                                                                                  .

City:                                                               State:              Zip/Postal code

Date of Birth:                                                  Phone:     (             )                                       .
 
 EX-KLINGON NAME: .                                                                                                         .
 
Just What Kind of Klingon Were You? (check one)

[]            Classic Klingon
                     I'm a Klingon as seen on the
                     Original STAR TREK series.

Other Clubs and Organizations which you will be joining in lieu of KAG:.                             .                                                                                                                   .

What was your complaint with the Klingon Assault Group?  Check One:

[] Too Much politics                              [] I have more fun at the Dentists         [] Oh, Just because
 

Mail Completed form and don't bother with a                           KAG
SELF ADDRESSED STAMPED ENVELOPE                      John Halvorson
to:                                                                                           The Beach CA