Welcome to W4AP - Montgomery Amateur Radio Club!

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MEMBERSHIP 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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