WESTSIDE AMATEUR RADIO CLUB, INC.

W5ABD

A P P L I C A T I O N    F O R    M E M B E R S H I P

NAME:___________________________________________ CALL:_____________

CLASS OF LICENSE:_______________________________ ARRL MEMBER:  Y  N

ADDRESS:___________________________________________________________

CITY:_____________________________________ STATE:______ ZIP:_______

PHONE NUMBER:____________________________ DATE OF BIRTH:___________

E-MAIL ADDRESS:____________________________________________________

TYPE OF MEMBERSHIP:

	___INDIVIDUAL			___ASSOCIATE

	___STUDENT (under 18)		___SUSTAINING

	___SPOUSAL MEMBER (spouse's call)_____________

	I hereby agree to abide by the constitution and by-laws, and such other rules as may be promulgated by the club.

						SIGNATURE:_______________________

                                                                   APPROVED BY:_____________________

DATE OF APPROVAL:________________

NOTICE TO APPLICANT:

	This application will be voted on by secret ballot and you will be notified of the results.  Dues are payable upon approval for membership.

Rev. 2/2003