Lincoln Trail Amateur Radio Club

Membership Application-Renewal Form

P.O. Box 342, Vine Grove, KY  40175

Name: ___________________________________________________________________

Address: ________________________________________________________________

City: _____________________________     State: __________     Zip Code:  __________

Phone: ____________________    Cell Phone ________________            Listed / Unlisted (Circle one)

Call:   ______________             Class of License:  ___________

Membership Dues:     $10.00 New or Renewal / One Year: Full Member

                                   $ 7.50 New / Nine Months: Full Member

                                   $ 5.00 New / Six Months / Same House: One Year Full

                                   $ 5.00 New / Associate Member (Non-License Holder)

Member ARRL:  Yes               No:                       Total Amount Paid:  ____________      Date Joined: __________________

Dues are from January 1st to December 31st and are due 1st Quarter of New Year. All previous members will pay Full Membership / One year dues with out regard to when they paid. ( Not Prorated)

The Information Below is very important for Roster & Printed Circuit.

Note: This info will be used for roster. Don’t provide it if you don’t want it published to other club members. This is also the mailing address you will receive the Club Newsletter at.

Name:  ___________________________     Call: ____________     Class License:  ______________

Address: ____________________________       Apt: _______     Box: ________

City: _________________________     State:  ______________     Zip: _________

Home Phone:   __________________

Member of ARRL:  Yes / No         Email address:  _________________________________