ELK COUNTY AMATEUR RADIO ASSOCIATION MEMBERSHIP APPLICATION

2009

Name:________________________________________________________________________

Call:______________________________ License Class____________________________

Address:_______________________________________________________________________

City:_______________________________ State:_________________ Zip:_____________

County:______________________________ Birthday:_______________________________

E-Mail Address:_________________________________________________

PLEASE CHECK APPROPRIATE MEMBERSHIPS:

[ ] ARRL [ ] ARES [ ] AIR FORCE MARS [ ] ARMY MARS [ ] NAVY MARS

[ ] QCWA [ ] OTHER____________________

[ ] VOLUNTEER EXAMIBER……………AFFILIATION [ ] ARRL [ ] LARC [ ] OTHER

PLEASE CHECK MEMBERSHIP TYPE:

[ ] Full Membership ($10.00) Requires Amateur License

[ ] Family Membership - $10.00 first family member; $5.00 each additional family member.

Number of family members ______

[ ] Associate Membership - $5.00. This covers anyone who cannot be a full member.

TOTAL AMOUNT ENCLOSED:_______________

Dues must be received by January 1, 2009. Please enclose your check or money order with this

application and bring both to the next meeting or mail to:

Mary A. Lewis N3UDN

1455 Montmorenci Rd.

Ridgway, PA 15853