RED OAK VICTORY AMATEUR RADIO CLUB c/o David Jackson

1451 Keiser Ave

Santa Rosa, CA 95404

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 David Jackson, Secretary

1451 Keiser Ave

Santa Rosa, CA 95404

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

$_________________

SS RED OAK VICTORY Contribution

$_________________

Other Contributions:___________________

$_________________

DATE: ______________________

Total Amount $______________________



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