RED OAK VICTORY AMATEUR RADIO CLUB c/o David Jackson
1451 Keiser Ave
Santa Rosa, CA 95404
APPLICATION FOR MEMBERSHIP / ANNUAL DUES
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ARRL Mbr? |
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Name:__________________________________ |
Call/Class _______________ |
Y__N__ |
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Family Member:_____________________________ |
Call/Class _______________ |
Y__N__ |
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Family Member:_____________________________ |
Call/Class _______________ |
Y__N__ |
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Address:_______________________________________________________________ |
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______________________________________________________________________ |
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Home Ph:________________________ |
Work Ph:________________________ |
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Publish phone numbers in membership roster? (Y/N) Home [____] Work [____] |
Fax Number:_____________________ |
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EMail:___________________________ |
Website:__________________________ |
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ANNUAL DUES AND DONATIONS: |
ROVARC Annual Dues $15.00 |
$_________________ |
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Payable to: |
Red Oak Victory Amateur Radio Club c/o David Jackson, Secretary 1451 Keiser Ave Santa Rosa, CA 95404 |
Family Mbrs, same address = ($15/ea) |
$_________________ |
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SS RED OAK VICTORY Contribution |
$_________________ |
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Other Contributions:___________________ |
$_________________ |
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DATE: ______________________ |
Total Amount $______________________ |
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