Hocking Valley Amateur Radio Club  (HVARC)
**** Membership Application (Rev. 9_2020)
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Email this completed form to hvarc.73@gmail.com, or print out and mail the completed form
to HVARC, 52 E. Second St., Logan, OH  43138 (or to the Club Secretary for faster service)
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Name:                                                                   Call Sign:

Mailing Address:

City:                                              State:                  Zip Code:

Phone Number:                            (Optional) Alternate/Mobile Number:

E-Mail Address:

I Do (   )   Do Not (   ) want to receive Email bulletins and the Monthly Newsletter from the HVARC 
  (May be changed at any time by notifying the Club Secretary)

I Am Applying For:	
Full Individual Membership (   )    
  $15/Year – Licensed Amateur Radio Operators Only  (Half year dues $7.50 after June 30)

Full Family Membership (   )
   $20/Year - Includes all Licensed Operators in Household  (Half year dues $10.00 after June 30)
   ** List Additional Applicant's Names and Call Signs in Additional Info Section

Associate Membership  (    )
   No Cost – for Non-Licensed Applicants Only - no Club voting rights

NOTE:  DO NOT SEND MONEY WITH THIS APPLICATION - YOUR DUES WILL BE DUE ONCE YOUR
APPLICATION IS APPROVED BY THE CLUB - Dues may be paid at Club Meetings, or mailed to 
HVARC, 52 E. Second St., Logan, OH  43138 (or the Club Treasurer)

Year First Licensed:

License Class:  Amateur Extra (   )    Advanced (   )   General (   ) 
                      Technician (   )     Novice (   )

Are you an ARRL Member? 

Interests in Amateur Radio (ie., HF, VHF, UHF, Digital, CW, ATV, etc.):

Other Amateur Radio Affiliations:

Are you subject to any current license suspensions or license revocation action by the FCC?:

(Optional) Employer and/or areas of experience (ie., electronics, computers, 
public relations, fund raising, etc.):

(Optional) Your Equipment which you may use or make available during an emergency:

How did you learn of our Club?:
 
Additional Info:



(Optional) Sponsored by:           

Signature:                                                                         Date:

----Club Secretary Use Only-------------------------------------------------------------------
Date Received:                                  Date Approved:
Remarks: