I, the undersigned, wishing to secure
for myself the pleasures and benefits of an association of persons commonly
interested in Amateur Radio, hereby request membership in The QSY
Society.
It shall be my purpose to further the
exchange of information and cooperation between members, to promote radio
knowledge, fraternalism and individual operating efficiency and to conduct
club programs and activities as to advance the general interest and welfare of
Amateur Radio in the community.
Fields marked with an
asterisk (*) are required.
Name*: Call*:
License Class*:
ARRL Member:
Address 1*:
Address 2:
City*:
State*:
Zip*:
Home Phone* (inc. area code):
Work Phone (inc. area code):
Email: Packet Mail:
Date of Birth* (mm/dd/yy):
Occupation (optional):
Amateur Radio Interests:
Waiver of Liability -
In consideration of membership and in view
of the voluntary nature of participation, I acknowledge and assume the risks of
the inherent and other dangers of participation in the Amateur Radio related
activities of the Club, including but not limited to, damage or destruction of
personal property, personal injury or death and I hereby waive any and all
claims and causes of action which I may have now or in the future and I release
and hold harmless the QSY Society, its officers and members, their assignees or
heirs from any liability or losses which I may incur.