Membership Application for the Elkhorn Valley Amateur Radio Club
P.O. Box 1033 , Norfolk, NE 68702-1033
Attn: Club Secretary
Note: Items marked with * are OPTIONAL all other fields are required.
FIRST NAME: Middle Initial *: LAST NAME:
HOME Phone: Cell Phone *: Work Phone
EMAIL: Web access: Yes No
CALL:             CLASS: EXPIRATION DATE:
ARRL MEMBER: Yes No Life     VE:Yes No ARES:Yes No If Yes
Enter Membership type applying for:
Enter Family Members names and call signs in box.
Are you interested in being a club officer, on a committee or have any specific interests or comments ?[Text limited to 3 rows of 80 characters. Feel free to use the back or attach another piece of paper.]
Signing this means you are willing to abide by the current Constitution & by-laws.
Print the form and mail it along with your check (made out to EVARC) to the address at the top of the form
Rev date: Dec 30, 2003