Membership Application

Click above to download application in PDF format

Name : _________________________________________

Amateur Call sign: _____________________________

Amateur Class: _________________________________

Number Of Years As An Amateur ? ___________

Address :________________________________________

Telephone Number : ___________________________

Email Address: _________________________________

Are You A Member Of The ARRL? Yes No

What Are Your Interests ? VHF/UHF, Digital, HF, Volunteer Examiner, Special Events? _____________________

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What Would You Like To See Most In An Amateur Radio Club ? _____________________________________________

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Club Contact : Tammy Smith Phone # 928-565-1136 Cell# 928-279-4078 Email : bratt_1973@hotmail.com