SCRAMS Club Membership Application

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Membership Application - Please fill in all fields below, and print out a copy this form.  For renewals, you can mail the form and your check directly to the club at SCRAMS, PO Box 1174, Waterford, CT. 06385.  Otherwise, bring the form, along with your $25.00 dues payment, to the next club meeting.

Your name:	Street address or PO Box No.:
Phone No. for AutoPatch Speed-Dial:	City or Town:
Your e-mail address:	State: Zip:

Your Call Sign:

Your License Class: Not Licensed Novice Technician Technician Plus General Advanced Amateur Extra

Membership Type: Regular Family Associate New membership or Renewal? New Renewal

Would you like serve as a club officer? Yes No

Would you like to serve on the Technical Committee? Yes No