Membership Application Form

Please print out, fill in and post to:

Brisbane Amateur Radio Club Incorporated
PO Box 6106
Upper MtGravatt QLD 4122 Australia

I, the undersigned, hereby apply for admission to membership of the Brisbane Amateur Radio Club. If accepted for membership, I agree to abide by the Constitution and By-Laws of the Club.

Name:

Address:

Email Address:

Post Code:

Home Telephone No.:

Occupation:

Amateur Callsign

If you wish any of the following to be omitted from published Membership lists, please tick the ones to be omitted.

Address

Phone No.

Signed:

Date:

Committee Use Only

Proposer:

M'ship No.:

Seconder:

M'ship No.:

Payment Received:

Receipt No.:

Date Accepted/Rejected:

M'ship No. Issued:

President:

Secretary: