FOOTHILLS AMATEUR RADIO SOCIETY
909 – 6 th. Street West
High River, Alberta, TIV-1B3
MEMBERSHIP/ RENEWAL FORM
PLEASE SUBMIT BY NOV. 30  AND MAKE CHEQUE PAYABLE TO:
FOOTHILLS AMATEUR RADIO SOCIETY.

New Membership: ________ or Renewal: _________ Date: __________________

Name:    _________________________________________ Call Sign(s): _____-_________
Address: __________________________________________________________________
Town / City: _______________________________________ Postal Code ____ - ________
Phone: Hm __________________ Wk: _________________ Emg.  Phone: ______________
Cell Phone:  ___________________________ Email: _______________________________

Member (2) Spouse or family members still at home

Name: _________________________________________________ Call Sign(s): __________
Phone: Hm __________________ Wk: _________________ Emg.  Phone: ______________
Cell Phone:  ___________________________ Email: _______________________________

MEMBERSHIP Annual Dues:

Single Membership is $25.00 per year  Fee Enclosed: ___________
Family Membership is $35.00 per year  Fee Enclosed: ___________
Associate Membership (non voting or office rights) $12.50
Student Membership    (non voting or office rights)  $12.50

Bands & Mode Active On (check box)
 
 

160m 80m 40m 30m
 20m 17m 15 m  12 m
 10m 6m  2m 70cm
SSB AM FM CW - Morse Code

ARE YOU ABLE TO HELP WITH:

  EMERGENCY COMMUNICATION   Yes: _______ No: _______ Maybe: _________
                                         FIELD DAY   Yes: _______ No: _______ Maybe: _________
                                     REPEATERS   Yes: _______ No: _______ Maybe: _________
                                       EXECUTIVE   Yes: _______ No: _______ Maybe: _________
                                                  NETS    Yes: _______ No: _______ Maybe: _________
 

Please complete other side & Personal Data Form
 

DO YOU WISH TO MAKE AN EXTRA CONTRIBUTION TO HELP WITH
                                                                                                                            Amount
Repeater Maintenance / Upgrades 
Emergency Communication
Club Station
Educational Workshops / Classes / 
(Alta. Soc. # 50658049)
 
 
 

Thank you in Advance for your kind Generosity
 
 

Comments:





 

To be Complete by the Treasurer / Secretary
Cheque #  Add to Database  Date
Date Deposited    By:
Receipt #
By: