MEMBERSHIP APPLICATION FORM

Membership in the North Brevard Amateur Radio Club is open to anyone with an interest in amateur radio or the goals of the organization. All memberships need to be renewed annually except for Life Membership which are available for a one-time contribution of two hundred dollars or more.

All memberships require the completion of an application form. Multiple family memberships are welcome, but a separate application form must be filled out for each person other than spouse.

Membership applications may be submitted on-line from this page or written applications containing the same information may be mailed to the NBARC Secretary at PO Box 1033, Mims, FL 32754-5462. All applications must contain the minimum information indicated below with an*asterisk.
Or better yet, Print it and bring it to the next NBARC Business Meeting with your check for the Dues. (It's 3 pages if you print it.)

*Name:

*Call Sign:

*License Class:

ARRL Membership:

Spouse Name:

Call Sign:

License Class:

ARRL Membership:

*Mailing Address:

*City:

*State:

*ZIP:

Family Membership:
YES NO

Other Memberships:

ARES RACES CAP

Volunteer Examiner:

ARRL W5YI

E-Mail Address:

Personal Web Site:

Home Telephone Number:

Newsletter Delivery Preference:

Birthday (Optional):

Comments, Suggestions:

I can now or will soon be able to operate on the following Frequencies:
160 meters
80 meters
40 meters
30 meters
20 meters
17 meters
15 meters
12 meters
10 meters
6 meters
2 meters
70 CM

Do you have a 2 meter Hand Held Transceiver (HT) YES NO

Have you worked Public Service Events YES NO

Can you help with Public Service Events? YES NO

Can you help as a Skywarn Spotter, or help with the
Evacuations Shelters if needed? YES NO

Did you take the ARRL ARECC classes. YES NO

If yes what Levels were you Certified for?

Membership Dues is for the Month Application is submitted

MEMBERSHIP TYPE

JANUARY - JUNE

JULY - NOVEMBER

DECEMBER *

FULL VOTING MEMBERSHIP
$20.00

$10.00

$20.00

FAMILY MEMBERSHIP
$5.00

$2.50

$5.00

JUNIOR MEMBERSHIP
$10.00

$5.00

$10.00

SNOW BIRD MEMBERSHIP
$10.00

$5.00

$10.00

ASSOCIATE MEMBERSHIP
$15.00

$7.50

$15.00

Membership Dues is for the Month Application is submitted
MEMBERSHIP TYPE	JANUARY - JUNE	JULY - NOVEMBER	DECEMBER *
FULL VOTING MEMBERSHIP	$20.00	$10.00	$20.00
FAMILY MEMBERSHIP	$5.00	$2.50	$5.00
JUNIOR MEMBERSHIP	$10.00	$5.00	$10.00
SNOW BIRD MEMBERSHIP	$10.00	$5.00	$10.00
ASSOCIATE MEMBERSHIP	$15.00	$7.50	$15.00

* Amounts shown reflect dues payment for next full consecutive year. For example, if your application is submitted at the December 2007 NBARC meeting, your application should be submitted with a check (or cash) in the amount of $20.00 (for full membership). That Dues payment covers calendar year of January through December. Your next dues payment would not be due until the following December. Annual Dues renewal is very December at the annual club meeting.

* Please submit your initial Dues Payment with our application, put your Call Sign on the Check so we can match it to this application. Only applications submitted with an appropriate NBARC Dues payment can be presented to the membership for acceptance.

How will you be sending the payment?

When you click "Send It", you will see a message asking if you want to continue. Click "OK" then click "SEND" for Your e-mail program to send your information.

Submit your application and mail your check for your membership Dues to:

North Brevard Amateur Radio Club
PO Box 1033
Mims, Florida 32754

Or you may bring it to our next Business Meeting.

North Brevard Amateur Radio Club is a nonprofit educational organization under IRS Part 501(c)3.

*Name:	*Call Sign:
*License Class:	ARRL Membership:

Spouse Name:	Call Sign:
License Class:	ARRL Membership:

*Mailing Address:

*City:
*State:
*ZIP:
Family Membership:	YES NO
Other Memberships:	ARES RACES CAP
Volunteer Examiner:	ARRL W5YI
E-Mail Address:
Personal Web Site:
Home Telephone Number:
Newsletter Delivery Preference:
Birthday (Optional):
Comments, Suggestions:

Do you have a 2 meter Hand Held Transceiver (HT)	YES NO
Have you worked Public Service Events	YES NO
Can you help with Public Service Events?	YES NO
Can you help as a Skywarn Spotter, or help with the Evacuations Shelters if needed?	YES NO
Did you take the ARRL ARECC classes.	YES NO
If yes what Levels were you Certified for?