Membership Application
Fill out, print this form, and mail to:

VALLEY AMATEUR REPEATER ASSOCIATION, INC.
Post Office Box 73
Streamwood, IL  60107

Callsign:   License Class:  
Name:
Address:
City: State:   Zip:  
Home Phone #:
E-Mail Address (if applicable):

Do not publish my phone # on membership rosters
Request autopatch membership (additional $15 in yearly dues)
Autopatch members receive two speed-dial slots.  If you know either of the numbers you want programmed,
place them in the boxes below.  Otherwise, you can wait and have these programmed at a later date.
1st slot:       2nd slot:  

NOTE:  Attach a photocopy of your Amateur Radio License to this form.
               Yearly regular membership dues for VARA is $30 (pro-rated from April to April)
               No additional dues required for family members living under the same roof.

I hereby certify that the attached is a copy of my valid Amateur Radio Operator License issued to me by
the FCC.  If I am accepted as a member of VARA, I agree to abide by the VARA constitution and by-laws.

(Please fill out this bottom portion by hand)

  (   )   I will attend the VARA meeting on ____________, at which time the present
members will vote on my application for membership.

  (   )  
I am unable to attend the VARA meeting on ____________. I have asked your
member ___________________ to serve as my sponsor.


Date: _______________   Signed: ______________________________________