Kalamazoo Amateur Radio Club
MEMBERSHIP APPLICATION
Name ________________________________________________________ Call____________________
Street Address__________________________________________________ Date ___________________
City___________________________________________ State________________ Zip________________
Home Phone__________________________________ Work Phone_______________________________
License Class_____________________ Email Address__________________________________________
New Member ð Renewal
ARRL Member ð RACES Member ð ARES Member
Other amateurs in your household
Name ________________________________________________________ Call_____________________
License Class_____________________ Email Address__________________________________________
Name ________________________________________________________ Call_____________________
License Class_____________________ Email Address__________________________________________
Name ________________________________________________________ Call_____________________
License Class_____________________ Email Address__________________________________________
Name ________________________________________________________ Call_____________________
License Class_____________________ Email Address__________________________________________
Type of Membership Dues
ð Regular & Family $20.00
ð Retired $10.00
ð Disabled $10.00
ð Student $10.00
ð Associate $10.00
ð Contribution $_________
Total Paid $_________
Make checks payable to KARC
Mail to: KARC
c/o Kalamazoo Red Cross
5640 Venture Ct.
Kalamazoo, MI 49009
RG RT DA ST CT TP DT C#