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#