Old Post Amateur Radio Society Membership Application Fill in all the information on the form and return it with the appropriate dues in person or mail it to the address above.
Name:	Call Sign:	License: Novice Tech Tech Plus General Advanced Extra
Address:	Status:3	Phone #:
City:	State:	Zip:
E-mail:	Date of Birth:	Year Licensed:

Other Memberships
ARRL	ARES	MARS	RACES	QCWA	10-X
Any other ham radio-related organizations, now or in the past?

Are you a Skywarn Member? If yes, what is your assigned number.

INTEREST

Please list all Amateur radio interest you have: CW, Packet, Fox Hunting, Contesting, etc.

Applying For Family Membership Please list below the licensed family members living at home, that you wish to include
Name	Call Sign	License Class	ARRL/Other memberships

Payment1 Due:
Single Member ($15.00)
Family Membership ($20.00)
Student Membership ($10.00)
ARRL Dues2
Total Enclosed

Notes:
1 - Payment made after October 31st applies to the membership for the following year.
2 - Your ARRL membership may also be paid through the club, enclose the appropriate forms with the amount due. ARRL also has a family membership program. See QST.
3 - Please indicate your membership Status in the space provided as: New, Renewal, Update (for mailings)  PRINT THIS PAGE