Membership Application
Annual Dues $10.00
Additional Family Members $5.00
Date:
__________
Callsign:
______________
Class: ________
Birthday: _________
Name:
_____________________________
Nickname: ________________
Address:
___________________________________
(Mail) Home
Phone: __________________
_______________________________
Bus. Phone: ________________
City,
State Zip: ______________________________
Other Phone: _______________
E-mail:
__________________________________________
ARRL MEMBER?: Y / N
Alternate
Power (emergency) Capabilities: HF,
VHF, UHF,
PACKET
Interests:
__________________________________________________________________
PDF
File Version of Application
Print out and complete this form (or
substitute) and bring to the next club meeting or send to the Treasurer:
Tippecanoe Amateur Radio Association, c/o American Red Cross, 111 S. 7th
Street, Lafayette, IN 47901