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W 1 C R S 
CONNECTICUT RADIO SOCIETY
Society
Membership Form
The Connecticut Radio Society
requests the following information.
Please fill-in all areas of this membership form. Mail to
callbook address.
Name:____________________________________________Call letters:____________
Address:_________________________________City:___________________State:_______Zip:________
Telephone #:____________________________Email address:_____________________
License class: [ ] General [ ]
Advanced [ ] Extra ARRL Leaque member: [ ] Yes [
] No Code Speed:____WPM
Ham radio interests: [ ] Contesting [ ] DXing [
] Special Events [ ] Rag Chewing [ ] Antenna work [ ] Other_______
Contest Software used: [ ] CT [ ] NA [ ] TR [ ]
Other:_______________________
Bands:HF[ ] 160 [ ] 80 [ ] 40 [ ] 30 [ ] 20 [ ]
17 [ ] 15 [ ] 12 [ ]10VHF:[ ] 2m [ ] 6m UHF:[
] 222 [ ] 440[ ]Other:_____
Modes: [ ] CW [ ] Phone [ ] RTTY [ ] Amtor [ ]
PSK31 [ ] Packet [ ] SSTV [ ] Other_______
Emergency power: [ ] Battery [ ] Automobile [ ]
None [ ] Other_______________
HOME STATION:
Transmitter/Transceiver:_________________________________Power:___________watts
Antennas:____________________________________________________________________
Contests Operated:_____________________________________________________________
Contest Awards Achieved:_______________________________________________________
Can members guest operate at your station? [ ] Yes [ ] No
Would you like to be a guest operator? [ ] Yes [ ] No
Would you prefer to be a contest operator? [ ] Yes [ ] No *
Special Event Operator? [ ] Yes [ ] No
Any skills (antennas, computer software, widget maker, etc.) that
may enhance the Society. Please list below.
______________________________________________________________________________________
______________________________________________________________________________________
Signed:_________________________________________________Date:_________________
Society Officer:___________________________________________Date:_________________
