HIGH DESERT AMATEUR RADIO CLUB
GENERAL
MEMBERSHIP APPLICATION
Please Print
|
|
|
|
|
FIRST NAME
|
Middle name or initial |
Last Name |
|
|
|
|
|
LIVING ADDRESS
|
CITY |
STATE, ZIP |
|
|
|
|
|
MAILING ADDRESS IF DIFFERENT |
CITY |
STATE, ZIP
|
|
|
|
|
|
HOME PHONE
|
WORK PHONE |
CELL PHONE |
|
|
|
|
|
OTHER PHONE |
PAGER |
EMAIL ADDRESS
|
|
|
|
|
|
OVER 18 ? YES or NO |
80 YRS OR OLDER? YES OR NO |
ARE YOU AN ADDITIONAL FAMILY MEMBER? YES OR NO
|
|
|
|
|
|
AMATEUR CALL SIGN
|
LICENSE CLASS |
EXPIRATION. DATE |
|
|
|
|
|
ARRL MEMBER Y / N
|
ARRL MEMBERSHIP # |
OTHER ORGANIZATIONS? |
MAIL COMPLETED APPLICATION WITH YOUR ACTIVE MEMBERSHIP $15 ANNUAL DUES JANUARY TO DECEMBER. ATTACH A FORM FOR EACH ADDITIONAL FAMILY MEMBER $5 EACH PER YEAR INCLUDING THOSE UNDER 18.
ACTIVE MEMBERS ARE FULL VOTING MEMBERS IF YOU DON’T HAVE YOUR LICENSE YET JOIN AS AUXILIARY MEMBER $15 PER YEAR OR AS ADDITIONAL AUXILARY FAMILY MEMBER AT $5.
CHECKS TO: HIGH DESERT AMATEUR RADIO CLUB
MAIL TO:
TREASURER Pat Nekoranec, 1500 Tulip, Rio Rancho NM 87124
CALL 505-892-1638 FOR INFORMATION
SIGNATURE ______________________________________________ DATE _____________________