Membership Application
Make checks payable to:  Bristol County Repeater Association, Inc.
Mailing address:  45 Beth Road.,  Tiverton,  R
I 02878-3701


___  Application for individual membership  Dues $20.00 per year

___  Application for family membership  Dues $25.00 per year

___  Application for Student membership (under 18) Dues $10.00 per year

___  Renewal of membership  Dues as above


                                    PLEASE  PRINT  CLEARLY


Callsign __________     License expiration __________     Class _________


Name ________________________________________________________


Address ______________________________________________________


City _________________________   State  _____  Zip _________________


E-mail address _________________________________________________


Home telephone number (Please include) ____________________________

If you do not want your telephone number listed it will be restricted to association officers.

Do you want your telephone number published on the monthly club roster?   Yes_____  No _____


Do you want a repeater speed dial allocated for your use?  Yes _____  No _____

Speed dial allows you to quickly dial the one phone number you call the most over the repeater.


Are you currently an ARRL member?   Yes _____ No _____

Would you like information about the ARRL?   Yes _____ No _____

Would you like an ARRL application?     Yes _____ No _____     Joining the ARRL through this club
benefits the club and costs no more than if you joined separately.  ARRL dues currently $39.00 per year.


Areas of interest:                 _____ Club May Dxpedition (Martha’s Vineyard)

                                                _____ Club ‘Geekfest     _____ Field Day

                                                _____ Emergency communications and participation


Please include any other information or questions: