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 Membership Application

New Bern Amateur Radio Club

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

Birthday is optional.  

Please print all information.

 

 

 

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.

 

Ray Hemphill

1508 Kimberly Rd.,

New Bern NC 28562

 

 

Current dues schedule: $30/year