Can we publish your phone number in the club roster ? yes
FCC License Expires on:
ARRL Member ? yes
ARES/RACES Member ? yes
Are you a registered VE ? yes
Do you have a tone alert system ? yes
Are you a registered Skywarn Observer ? yes
Are you a MARS Member ? yes
if so, which one ?
How long have you been a licensed amateur ?
Are you a member of the QCWA ? yes
Do you have a electric generator ? yes
If so, what size ?
In the event of an actual emergency, would you object to being called at anytime to assist ? yes
Please list any toll call that you might place on the Autopatch
Please indicate the equipment you have:
2 Meter Home
6 Meter Home
2 Meter Mobile
6 Meter Mobile
2 Meter Handheld
6 Meter Handheld
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:
Retired or Student
For Family Memberships, please list family members names and calls.
Simply fill in the form,
Print out page 1
and mail it along with a check or money order for the proper amount to:
Triple A Amateur Radio Assoc. Inc.
141 Woods Run
Darlington, PA 16115
Webmastered by: firstname.lastname@example.org
© 2013 The Triple A Amateur Radio Association Inc.