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Printable VersionMEMBERSHIP APPLICATION
Year___________
Montgomery Amateur Radio Club – PO Box 3141 – Montgomery, AL. 36109
Renewals enter, name and callsign and any changes in status.
*Note: Senior Members over 70 please send in application to keep roster updated.
New Members enter all available information.
Name:______________________________ DOB:______________ Call:___________ Class:______ ARRL Member(Y/N)___
E-mail:__________________________
Family Members
Name:______________________________ DOB:______________ Call:___________ Class:______ ARRL Member(Y/N)___
E-mail:__________________________
Name:______________________________ DOB:______________ Call:___________ Class:______ ARRL Member(Y/N)___
E-mail:__________________________
Name:______________________________ DOB:______________ Call:___________ Class:______ ARRL Member(Y/N)___
E-mail:__________________________
Class of License: N= Novice, T= No Code Technician, T+= Code Technician, G= General, A= Advanced, E= Extra
Address:_________________________________________________________________
City:______________________________ State:_____________ Zip:____________
Home Phone:_______________________ Work Phone:_______________________
Indicate Membership type below. Membership fees are due every January 1st. There is a 60-day grace period.
Family membership is for immediate family with 2 or more amateur radio license holders residing at the same
address.
Associate Membership is for individuals who do not have an amateur radio license, but are interested in the
activities of the club and are preparing for exams.
Senior Membership is for an amateur age 65 or older.
Check type of membership:
______Single Membership ($25 per year)
______Family Membership ($40 per year)
______Senior Membership - age 65-69 ($15 per year)
______Senior Membership - age 70+ (no charge)
______Associate Membership ($10 per year) |
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