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Tuesday, 09 September 2008 02:50 |
Stones River Amateur Radio Club
Membership Documentation for Year 20____
New Member ___ Renewal ___ Update My Records ___
Single: $12.00 ______ Family: $16.00 _____ Associate (Non-Voting): $6.00 _____
Name: __________________________ Call sign: _________________
Address: ___________________________________________________
City: _______________________ State: _______ Zip: _______________
Home phone: _______________ Published ?: ____________________
Work phone: ________________ (Yes/No)
Occupation: ______________ _ License class: ___________________
Internet e-mail address: _____________________@________________
Internet access: Yes: ______ No: ______
Bands used: ________________________________________________
Modes used: ________________________________________________
Emergency power capable? Yes: _____ No: ______
*ARRL member? Yes: _____ No: _____
ARES member? Yes: _____ No: _____
County: _______________
Are you a volunteer examiner Yes: _____ No: ____ w/ARRL?:_____
Other amateur radio club affiliations: _____________________________
___________________________________________________________
Do you monitor a VHF repeater?: ______ If so which one?: __________
Any other hobbies or interest: __________________________________
__________________________________________________________
Please include any other information about yourself or areas of interest,
in Ham Radio or otherwise.
_________________________________________________________
_________________________________________________________
Make check payable to: Stones River Amateur Radio Club
Mail to: SRARC, P.O. Box 54, Smyrna, TN 37167
*SRARC is an ARRL Affiliated, Special Service Club.
ARRL Membership is preferred, but not mandatory.
Rev. 7 April 2003
Other Family Members (if family membership):
Name: ____________________________ Call sign: ______________
Work phone: ________________
Occupation: _________________ License class: __________
Internet e-mail address: _____________________________________
Internet access: Yes: ______ No: ______
Bands used: ______________________________________________
Modes used: ______________________________________________
*ARRL member? Yes: _____ No: _____
ARES member? Yes: _____ No: _____
Are you a volunteer examiner Yes: _____ No: ____
With w/ARRL?:______
Name: ____________________________ Call sign: ______________
Work phone: ________________
Occupation: _________________ License class: __________
Internet e-mail address: _____________________________________
Internet access: Yes: ______ No: ______
Bands used: ______________________________________________
Modes used: ______________________________________________
*ARRL member? Yes: _____ No: _____
ARES member? Yes: _____ No: _____
Are you a volunteer examiner Yes: _____ No: ____
With w/ARRL?:______
Name: ____________________________ Call sign: ______________
Work phone: ________________
Occupation: _________________ License class: __________
Internet e-mail address: _____________________________________
Internet access: Yes: ______ No: ______
Bands used: ______________________________________________
Modes used: ______________________________________________
*ARRL member? Yes: _____ No: _____
ARES member? Yes: _____ No: _____
Are you a volunteer examiner Yes: _____ No: ____
With w/ARRL?:______
Rev. 7 April 2003
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Membership Application
