RED OAK VICTORY AMATEUR RADIO CLUB c/o Peter Hoffman
1123 Harrison Street
Berkeley, CA 94706
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 Peter Hoffman, Treasurer 1123 Harrison St. Berkeley, CA 94706-2230 |
Family Mbrs, same address = ($15/ea) |
$_________________ |
|
SS RED OAK VICTORY Contribution |
$_________________ |
||
|
Other Contributions:___________________ |
$_________________ |
||
|
DATE: ______________________ |
Total Amount $______________________ |
||