RED OAK VICTORY AMATEUR RADIO CLUB c/o Ed Garbin

852 Alonda Court

Hayward, CA 94541

APPLICATION FOR MEMBERSHIP / ANNUAL DUES

 

ARRL Mbr?

Name:__________________________________

Call/Class _______________

Y__N__

Family Member:_____________________________

Call/Class _______________

Y__N__

Family Member:_____________________________

Call/Class _______________

Y__N__

Address:_______________________________________________________________

______________________________________________________________________

Home Ph:________________________

Work Ph:________________________

Publish phone numbers in membership roster? (Y/N) Home [____] Work [____]

Fax Number:_____________________

EMail:___________________________

Website:__________________________

ANNUAL DUES AND DONATIONS:

ROVARC Annual Dues $15.00

$_________________

Payable to:

Red Oak Victory Amateur Radio Club

c/o Ed Garbin, Treasurer

852 Alonda Court

Hayward, CA 94541

Family Mbrs, same address = ($15/ea)

$_________________

SS RED OAK VICTORY Contribution

$_________________

Other Contributions:___________________

$_________________

DATE: ______________________

Total Amount $______________________



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