Membership Form

RICHMOND AMATEUR RADIO CLUB, INC.
(ARRL SPECIAL SERVICE CLUB)
P.O. Box 35279, Richmond, Va. 23235

APPLICATION FOR MEMBERSHIP

First Name

First and Last name

Last Name

Call Sign

Enter call sign if you have one

Street Address

Phone Number

Type

Home, Cell

City

State

Zip Code

Email address

Year of Birth

YYYY

Enter the name and address as you wish it to appear on the membership roster

ARRL

Yes

Member of ARRL

Hand-held

Yes

Do you own a hand-held or battery powered transceiver

Emergency List

Yes

Would you be willing to have your name on the emergency call up list

Teach

Yes

Are you willing to teach or assist in the amateur radio school classes?

Class of License

What amateur radio activities are you most interested in?

Interest1

VHF

Interest2

RTTY

Packet

Traffic Handling

Interest3

Satellites

Contesting

Other Interest

Skills

Application Date

Payment option

Cash or Check

Credit or Debit Card or PayPal

Dues are $22.00 Discounted to $20.00 for Cash or Check payment

NEW MEMBERS: Dues are based on Nov.-to-Nov. club year, (50% after May 1).
Dues: $22.00 per year, per person, payable to R.A.R.C. on Nov. 1st of each year.
Persons over the age of 81 are not required to pay dues to be a member. Select the Cash or Check Payment option.
Newsletter: "THE RICHMOND HAM" is published and e-mailed monthly to all members.

Submitting this form is your request to become a member of the Richmond Amateur Radio Club. Membership will be voted on at the next meeting.