(Print this form, fill it out and mail to the address below)
HEART OF AMERICA RADIO CLUB
WØRR
Kansas City, Missouri
Dues: $12.00 annually for Individuals, $5 each additional family
member.
For first time individual applicants, dues are prorated quarterly based on
application date:
$12.00 if applying during Jan-Mar, $9.00 Apr-Jun, $6.00
Jul-Sep, $3.00 Oct-Dec
Membership application for the year ending December 31, ______________
Membership Type: ____ Individual ____ Family
| Date of Application: | _________________________ |
| Name: | ________________________________________________________ |
| Call Sign: | ___________ |
| Address: | ________________________________________________________ |
| City, State Zip: | ________________________________________________________ |
| Home Phone: | _______________________ |
| Work Phone: | _______________________ |
| E-Mail Address: | _______________________ |
| ARRL Member? | _____ Yes _____ No |
Family Membership (List additional family members below. Dues: $5 each additional member):
Name: ________________________________________________ Call Sign: _____________
Name: ________________________________________________ Call Sign: _____________
Name: ________________________________________________ Call Sign: _____________
Signature: __________________________________________________________________
Send application with your check to:
Heart of America Radio Club
PO Box 414054
Kansas City MO 64141-4054