Membership Application

New Bern Amateur Radio Club

Please fill out this application so that we can establish Club membership records. 

Birthday is optional.  

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Current Call Sign _______________________________________________________

 Date ____________________________________________________________________

 Previous Call Sign (if applicable)_______________________________________

 Name_____________________________________________________________________

 Birthday ________________________________________________________________

Spouse___________________________________________________________________

Address__________________________________________________________________

City_____________________________________________________________________

State________________ Zip______________

Telephone (_____)___________________  Cell (_____) ______________________

Email Address____________________________________________________________

License Class and date Earned :

Technician ____________________________  

General    ____________________________

Advanced   ____________________________  

Extra      ____________________________

Are you a member of any of these organizations?/Plan to join?

A.R.E.S. ____________  ARRL ___________________ 

M.A.R.S. ____________  VE _____________________

Would you be willing to serve as a Club officer in the future?  

_________________________________________________________________________

What type of Club activities would you be willing to help with?

_________________________________________________________________________

Please list what parts of Amateur Radio is of interest to you.

_________________________________________________________________________

_________________________________________________________________________

When completed mail to the club or bring to a meeting with a check for $20 (annual dues).
NBARC - Ted Warnock
c/o: GARRIS TV
3104 Neuse Blvd.
New Bern, NC 28560
Ph: (252) 638-4477 shop
Ph: (252) 670-9955 Cell