___ 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 _________
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 (
_____ Club ‘Geekfest’ _____ Field Day
_____ Emergency communications and participation
Please include any other information or questions: