S
CHUYLKILL AMATEUR REPEATER ASSOCIATION, INC.W3SC
145.370
147.345
146.955
444.950
MEMBERSHIP APPLICATION:
Call ____________________
Name_____________________________________________________________
Address___________________________________________________________
City ______________________________________ State _______ Zip_________
County________________________ Phone Number ( _____ ) _______ - _______
License Class ________________________ Year Orig. Licensed
______________
I am a member of: RRL ____ ARES ____ RACES ____ MARS ____
CAP ____
I enclose my dues at the rate of $1.25 per mo. from now through
Dec. of the current year.
Signature ____________________________________
Date_________________
Dues are payable annually on January 1st, in the
amount of $15.00 per year.
Make check payable to: S.A.R.A.
Mail to: S.A.R.A., P.O. Box 901, Pottsville,
PA 17901-0901
Recommended by:
___________________________________________________
Date presented:
________________________
Approved: _____ Disapproved: _____
Reason: ___________________
Dues: Amt. due: ___________
Rcvd. by: ____________ Date: ______________
Application form 01/01/03