Founded in 1929

NAME:________________________________________________CALL SIGN:_____________________

ADDRESS: _____________________________________________PHONE:________________________

CITY: _________________________________________________STATE:________ZIP:_____________

Enter the name and address as you wish it to appear on the membership roster. For telephone indicate whether it is home or office.

E-mail Address:__________________________________________

Are you a Member of ARRL? Yes______No______CLASS OF LICENSE: __________________________

Emergency Operations: Would you be willing to have your name on the emergency call up list, and be called if needed? Yes______No______

Do you own a hand-held or battery powered transceiver? Yes ______ No ______

Please identify the frequency bands on which your battery-powered transceivers(s) can operate:__________

Are you willing to teach or assist in the amateur radio school classes? Yes ____ No ____

What amateur radio activities are you most interested in? (Circle one) CW, DX, VHF, RTTY, PACKET,

TRAFFIC HANDLING, SATELLITES, CONTESTING, OTHER: ___________________________________

List any special skills that you have that could be used to benefit the club: ____________________________

_______________________________________________________________________________________

Are you interested in serving on any special committees: (i.e. Social, history or programs)? ______________

________________________________________________________________________________________

APPLICANT'S SIGNATURE: _____________________________________________

Application Date: __________________ Date Application Approved: _____________

Dues Enclosed: CASH _____________ CHECK ___________ CHECK#_____________

NEW MEMBERS: Dues are pro-rated based on Nov.-to-Nov. club year, (50% after May 1).

Dues: $15.00 per year, per person, payable to R.A.R.C. on Nov. 1^st of each year. Those age 12 and under, dues are $5.00, ages 13 through 18, dues are $10.00. Persons over the age of 80 are not required to pay dues to be a member.