Ashe County Amateur Radio Club, Inc.
Please fill out this form, print it, and mail it to
P.O. Box 545
Jefferson, NC 28640
I hereby apply for:
Full voting membership at $20.00/year
Number of additional Family Members ($5.00 for each)
Associate membership at $7.50/year
NOTE: Memberships are on a calendar year basis. Associate memberships are for part-time or summer residents.
Name:
Callsign:
Mailing Address:
E-911 Address:
City:
State:
Zip:
Home Phone:
Work Phone:
E-mail:
Current License Class: Novice
Technician
General
Advanced
Extra
ARRL Member:
MARS:
Voluenteer Examiner: W5YI
ARRL
Have you ever had you station license suspended or revoked?
No
Yes If yes, please state reasons...
Signature:
Date:
