Membership Application Form

Annual Dues are $25.00. Family members in the same household that are amateurs will be associated at no additional charge. Dues for NEW MEMBERS joining in April, May or June will be $15.00; July, August or September $10.00; October, November or December $5.00. RENEWING MEMBERS always owe the full $25.00.

This is a New Member ApplicationCurrent Member Update
Call Sign License Class NoviceTechnicianTechnician PlusGeneralAdvancedExtraOther (foreign) Birthday
Name
Address
City State Zip Code
Email
OK to list in Club Directory?
Cell Phone YesNo
Home Phone YesNo
Work Phone YesNo

Family Members with Amateur Radio Licenses who are to be associated with this membership:
Family Member Name(s) and Call Sign(s):

Please check the boxes below that correspond to areas in which you would consider participating.
Public Event Support (races, parades, walks)Public RelationsWeather SpottingVolunteer ExaminerAmateur Radio Emergency Service (ARES®)Monthly Club ProgramsARRL Field Day'Elmer' for new club memberSimulated Emergency TestNewsletter EditorAmateur Radio InstructorChristmas Dinner