Membership Application (No license is required to be a member of our club.) (PLEASE PRINT) Date __________________________ Name ___________________________________________________ Address __________________________________________________ City __________________________ State _____ Zip _________ Telephone _________________________________ E-mail ____________________________________ Call Sign _______________ Class __________ Expires _________ ARRL Member? ____________ Birth Month and Day __________ How did you hear about our club? ___________________________ What are your major interests in the hobby? _______________________ Bands & Modes operated _____________________________________ Membership: Individual ____ Family _____ (If family, include separate application for each individual) Please enclose annual dues as follows: Adult: $15 Age 18 or younger: $7.50 Family (3 or more individuals of immediate family): $32 Checks or Money Orders may be made to Pueblo West Amateur Radio Club, Inc. Send to: Dan Broadbooks, Treasurer, 1078 W. Desert Sage Dr., Pueblo West, CO 81007