Logan County Amateur Radio Club

Membership Application

                      ____New      ____Renewal
Full Name:____________________________     Call Sign:_________________
Name used on the air:_________________     
Address:______________________________     Phone (    )___________
___________________   Zip:____________                
E-Mail address:_________________________________________
                       License Class
___ Novice             ___ Technician           
___ General            ___Extra
Membership Category 
Membership is $24 a year and $6 a year for each additional member in 
your house. Or you may choose to pay on a monthly basis at $2 a month.                               
Signature________________________          Date_______________________

Welcome to the Logan County Amateur Radio Club!
 Your cancelled check is your receipt.
Make checks payable to the Logan County Amateur Radio Club

Send check or money order along with application to:

Logan County Amateur Radio Club
P.O. Box 792
Switzer, W.V. 25647