WESTERN PENNSYLVANIA REPEATER COUNCIL

MEMBERSHIP APPLICATION

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Membership Dues are used to pay for the activities of the W.P.R.C. including; frequency
coordination, mediation services, representing your interests to other adjoining repeater
councils, postage, phone calls mailbox rental, office supplies, as well as many other
services necessary to exist in an ever growing world of amateur radio.

Please fill in all of the information listed below, and check the appropriate boxes.

Note To Multiple Repeater Owners: If you wish to represent all of your repeaters, you may,
but you will only have one vote. You may elect to appoint a representative for each repeater.
Each representative present at W.P.R.C. meetings will have one vote. However, each repeater
must be a current member of W.P.R.C. and dues are subject to each.

1. Type Of Application:
NEW ___ RENEWAL ___
2. My Group/I Am A Member Of:
A.R.R.L. ___ A.R.E.S. ___ R.A.C.E.S.___
3. Organization Name or Individual Name: ___________________________________________________________________________________
4. Repeater call Sign That You represent: ____________________________________________
5. Repeater Frequency (One per membership): __________________________________________ MHz
6. Repeater Trustee's Name and Call Sign: ______________________________________________________________
7. Primary Representative To W.P.R.C.: (Call Sign and Full Name)
_____________________________________________________________________________________________
8. Secondary Representative To W.P.R.C.: (Call Sign and Full Name)
_____________________________________________________________________________________________
9. Mailing Address (U.S. Postal Mail Address)
_____________________________________________________________________________________________
10.Primary Representative's Phone NUmbers:
Home: _______________________________________ Work: _______________________________________
11.Packet Radio Email Address (If applicable): _______________________________________________
12.Internet Email Address (If applicable): _______________________________________________
13. Please Sign And Date This Application:
________________________________________________ Date: ___________________________

2006 Dues $10 Per Repeater. Make Checks Payable to the 'WESTERN PENSYLVANIA REPEATER COUNCIL'
and send via U.S. Mail to: W.P.R.C., PMB 173, 10592 PERRY HIGHWAY, WEXFORD PA 15090-9244

-------------------------------- W.P.R.C. Office Use only ---------------------------------

Please Insert Your Call Sign And Initials To Show That You Have Accomplished Your Task.
Membership Type Approved: ________________________________ Chairman: ____________________
Membership List Updated (Secretary or Treasurer): ___________
Dues Collected (Treasurer): ______________
Form 109/1202WP