ADELAIDE   HILLS 

AMATEUR   RADIO   SOCIETY   INC.

==  VK5BAR  ==

APPLICATION  FOR  MEMBERSHIP

(Please use Block letters).

 

FAMILY/ SURNAME ……………….…………………FIRST/GIVEN NAME...........………...........................

  PREFERRED GIVEN NAME...................................……………PARTNER'S (1st.) NAME. ……..……........…

 OCCUPATION..............……….…….......................... E-MAIL ADDRESS*.......................................................

ADDRESS*..............................................……..............................................……..............................................

...............................................................……..SUBURB.................………..............POSTCODE………………

'PHONE No/s*.     (MAIN).............................................................(2nd).................................…..........

                                        (OTHER) ………………………………………….  [Please indicate Work No. with “W”].

CALLSIGN (if any)...............................................................

If no callsign:  Are you taking/considering taking, any course with a view to becoming licensed ?  YES/NO.

If "YES" please provide brief details...............................................................................................................

 

·       Are you a member of the W.I.A.?                  

YES /NO.

·       Do you possess an "A.H.A.R.S.” Club badge?  

YES / NO

·       Do you have any special expertise which you would be willing to:

1. Speak about at a club meeting? YES/NO.

2. Assist the club in its activities? YES/NO 

.........................................................…………………........

 ............................................................……………………
If "YES" please provide brief details above.

I AGREE TO ABIDE BY THE CONSTITUTION AND BY-LAWS OF THE ADELAIDE HILLS AMATEUR RADIO SOCIETY INC.

Signature..........................................................................                                    Date   ......../......../….........
 

*I  do  NOT  want  these  details  placed  on  the  club  Public  Register.
NB: Occupation and Partner’s name will not be placed on the Public Register.

 

 

 
(Tick box). 

 

 

Further club information: See document AHARS-Club-Info-2010.

Offer  to  members considering study. See document Claim for Subsidy of Study Fees-2010.


CLUB   RECORDS   NOTED
 

Subscription   ($________) Rec'd

Application accepted

Entered in database.                                     

….… ..../……/20…… Treasurer) …..…..…………...

 ……..…/……/20……  (Secretary)  …………………

.……./…….. /20.....…

Postal Address:  P.O. BOX  401,  Blackwood, South Australia 5051.                Website:   http://www.qsl.net/vk5bar

             AHARS - Appn form Membshp Aug-2010.htm                                                                                                                  06/09/2010