I am interested in the following type of membership (circle one): Regular Junior Associate |
ARRL member?: Yes No |
Name: |
Call:
License Class: Extra Advanced General Technician Plus No Code Technician Novice
Year First Licensed: |
Address 1: |
Address 2: |
City: |
State: |
Zip: |
Phone (H):
Phone (W): |
Station Equipment (include mobile):
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Current Interests: (e.g. Contests, DX, Nets, etc.):
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List any area(s) you may be able to help with:
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Awards or Noteworthy Achievements:
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Have you ever been a member of FARA in the past?: Yes No |
