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. 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: Not Licensed Novice Technician Tech Plus General Advanced Amateur Extra ARRL Membership: Non-Member Annual Life Member
Spouse Name: Call Sign: License Class: Not Licensed Novice Technician Tech Plus General Advanced Amateur Extra ARRL Membership: Non-Member Annual Life Member
*Mailing Address:*City:*State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware FL Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming *ZIP:Family Membership:YES NO Other Memberships:ARES RACES CAPVolunteer Examiner:ARRL W5YIE-Mail Address:Personal Web Site:Home Telephone Number:Newsletter Delivery Preference: None Wanted E-Mail Web Site Regular Mail Birthday (Optional): JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 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? | LEVEL 1 LEVEL 1,2 LEVEL 1,2,3 |
Membership Dues is for the Month Application is submittedMEMBERSHIP TYPEJANUARY – JUNEJULY – NOVEMBERDECEMBER *FULL VOTING MEMBERSHIP$20.00$10.00$20.00FAMILY MEMBERSHIP$5.00$2.50$5.00JUNIOR MEMBERSHIP$10.00$5.00$10.00SNOW BIRD MEMBERSHIP$10.00$5.00$10.00ASSOCIATE 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? I will Mail it to the PO Box I will be coming to the next Meeting
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
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.