APPLICATION FOR 2000 MEMBERSHIP
CENTRAL ILLINOIS HIGH GAIN AMATEUR RADIO CLUB
http://communities.msn.com/CentralILHighGainAmateurRadioClub


FULL NAME (Please Print) 

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			First 			Middle 			Last

ADDRESS_________________________________________________________________________


CITY______________________________ STATE ________ ZIPCODE_______________________

DAYTIME PHONE (______) _________________HOME PHONE (_____)______________________

E-MAIL ADDRESS_______________________WEB PAGE ADDRESS___________________________

CALL SIGN ___________________________LICENSE CLASS _____________________________


PERSONAL BACKGROUND SELECTIONS

We maintain information on our members to assess interest trends and to identify members with specific expertise as needed. This is optional information.

Hobbies ________________________________________________________________________________
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Interests ________________________________________________________________________________________________________________________________________________________________
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Signed ________________________________________Date ____________________________
			Applicant



Membership Accepted: 	  YES   /    NO


Dues Received ________________________________Date Received_____________________

Officer Signature ____________________________Date _____________________________				Club President