VPS HostingFree Control Panel, full root access
Virtuozzo Containers, $25.00/month
Reseller HostingReseller hosting services, domains,
vps, dedicated servers. Join free!
WCARS Membership Application
Print this page or download the application
here.
Payment is required at the time the application is received.
Bring this application to a club meeting or mail it with your dues to:
John Rodenbarger WB9OFG (WCARS), 207 North Prarie Street, Brookston, IN 47923
WCARS MEMBERSHIP APPLICATION
NEW
MEMBER RENEWAL (circle one)
Amateur Call Sign
_____________
License Class
(circle one) Novice Technician General Advanced
Extra
Name
______________________________________________
Address
_______________________________________________
City
________________________
State
_______
Zip
___________
Email address
___________________________________________
Home Telephone
__________________________
Work Telephone
___________________________
Cell Telephone
__________________________
Date of Birth
_____ / _____ / _____ (mm/dd/yy)
ARRL Member
Yes No Life
Interests ______________________________________________________
Receive the WCARS newsletter by:
US Mail Email (please check only one)
Type of
Membership Optional Contributions
Individual $25.00 annually ____________ Repeater Fund Donation $ (not required)
________________
Student $15.00 annually
Senior $15.00 annually (over age 65)
Family ** $35.00 annually
** Available for family members residing at the
same address
Additional Family Members **
Name
_______________________________________
Date of Birth
_____ / _____ / _____ (mm/dd/yy)
License Class
Technician General Extra ARRL
Member Yes No Life
Interests
____________________________________________________________
Name:
______________________________________
Date of Birth
_____ / _____ / _____ (mm/dd/yy)
License Class
Technician General Extra ARRL
Member Yes No Life
Interests
_____________________________________________________________
I agree to abide by the By-Laws of the White
County Amateur Radio Society and
understand that membership is subject to the
approval of the Club.
Applicant Signature
___________________________________________
Date
_____ / _____ / _____
For more information contact
n9rla@arrl.net
©2009 All Rights Reserved. • Design by
Bob Aldrich, N9RLA
