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Membership Application............... New Member_____
Renewal_____
Hiawatha Amateur Radio Association of Marquette County, Inc.
P.O. Box 1183
Marquette, Michigan 49855
Name:______________________________________________ Callsign:___________________
Address:___________________________________________ License Class:______________
City:____________________________ State:_____ Zip:_______ Phone ________________
Today's date:________________ Date of Birth:________________
ARRL Member?: Yes___ No___
Email address:__________________________________________________
To become a full member you must be a licensed amateur and a resident of Marquette
County (MI). If you do not qualify for full membership, you can join as an associate
member. Associate members do not have voting privileges. Club dues are $15 per
individual, $20 for family memberships, $10 for associate membership and $15 for family associate
membership. A full-time student under the age of twenty-five membership is also available at
$7.50. (Family members must reside in the same household.) Our club year starts on
September 1st and ends August 31st.
FOR NEW MEMBERS ONLY, dues paid before May 1st will expire on August 31st of the same year, with
dues paid after May 1st your membership will be good until August 31st of the following
year.
(Membership renewal must be paid up prior to the annual election of officers meeting in October if
you wish to vote in said election.)
Please check type of membership desired:
___ Individual Full membership......$15/yr.
___ Family Full membership......$20.yr.
___ Associate membership...$10/yr.
___ Associate family membership...$15/yr.
___ Student membership...$7.50/yr.
Family Membership, list family members and callsigns:
1:____________________________________________________
2:____________________________________________________
3:____________________________________________________
If you hold a technician or higher class amateur license and you would like to have a
repeater voice mailbox and autodial access code assigned to you, please check here:______ If
the telephone number listed here is not a local call from the Marquette exchange, you will have only
a voice mailbox since only local calls are permitted on the autopatch. Telephone number to
be programmed into the repeater auto dialer:_____________________
It is not necessary to complete the rest of this form. The following information
may be used as your introduction to our club members in our newsletter.
Occupation:______________________________________________________________
Single ____ Married ____, Spouse's name and callsign (if Licensed):___________________
Briefly describe you rig(s) and
antennas:__________________________________________
_________________________________________________________________________
_________________________________________________________________________
Favorite ham activities: (Check as many as you wish)
____ Nets ____ Contests ____ Ragchewing ____ DX'ing ____ RTTY ____ Amtor ____ Packet ____ CW ____ ATV
____ Repeaters ____ Satellite ____ Field Day ____ ARES/RACES ____ Public Service Events ____
Other:_______________________________________________________________________________
Please print and mail this form with the appropriate dues to the address above.
Thank you.
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