TAARA Application

Membership Application

Name: Call:
Address:
City: State: Zip: Age: Birthdate:
Home Phone: Unlisted Business Phone: Extension:
Can we publish your phone number in the club roster ? yesno
Occupation:
License Class: FCC License Expires on:
ARRL Member ? yesno ARES/RACES Member ? yesno Are you a registered VE ? yesno
Do you have a tone alert system ? yesno Are you a registered Skywarn Observer ? yesno
Are you a MARS Member ? yesno if so, which one ?
How long have you been a licensed amateur ? Are you a member of the QCWA ? yesno
Do you have a electric generator ? yesno If so, what size ?
In the event of an actual emergency, would you object to being called at anytime to assist ? yesno
Please list any toll call that you might place on the Autopatch

Please indicate the equipment you have:

2 Meter Home	220 Home	440 Home	6 Meter Home
2 Meter Mobile	220 Mobile	440 Mobile	6 Meter Mobile
2 Meter Handheld	220 Handheld	440 Handheld	6 Meter Handheld
HF Rig	Packet	RTTY	ATV
Rain Gauge	Wind Gauge	Barometer	Thermometer

Types of Membership
There are four different types of memberships :
Individual $20.00 per year.
Family membership which is $20.00 for the first family member and $7.50 for each additional family member.
Retired or student membership, $10.00
Associate membership which has no voting privileges is $7.50 per year.
Dues are to be paid to the club treasurer by December 31 for the following year.

Select the membership you desire:
New Member Renewal Individual Family Retired or Student Associate
For Family Memberships, please list family members names and calls.
1. 2
3. 4

Members Signature:______________________________________________Date:________________________

Simply fill in the form,
Print out page 1
and mail it along with a check or money order for the proper amount to:
Treasurer
Triple A Amateur Radio Assoc. Inc.
141 Woods Run
Darlington, PA 16115