PLEASE PRINT THIS, FILL IT OUT AND BRING IT TO THE NEXT BUSINESS MEETING

Gadsden Amateur Radio Club - Application for Membership

Print Out and Bring or Mail to:

Gadsden ARC, P.O. Box 392, Gadsden, AL 35902-0392

General Information:

Name:______________________________________________ Callsign:_________________

Address:____________________________________________ License Class:____________

City:_____________________________________ State:____ Zip Code:_________________

Home Phone:_______________________ Spouse's Name:____________________________

Place of Employment:___________________________________ Work Phone:____________

Work Schedule:______________________________________________________________

Emergency Preparedness:

Bands You Can Operate On (Please circle all that apply):

Fixed: 1.2 440 222 144 6 10 12 15 17 20 30 40 80 60 ATV Packet

Mobile: 1.2 440 222 144 6 10 12 15 17 20 30 40 80 60 ATV Packet

Battery Power: 1.2 440 222 144 6 10 12 15 17 20 30 40 80 60 ATV Packet

Emergency Power: 1.2 440 222 144 6 10 12 15 17 20 30 40 80 60 ATV Packet

Portable/H T: Y N Band(s):_____________

Are You A Member Of:

MARS: Y N Branch:________________

National Guard: Y N Branch:________________

Red Cross: Y N

Emergency Management Agency: Y N RACES ID Number:_______________

Rescue Squad: Y N

A.R.R.L: Y N

Other Emergency Organization (Specify):______________________________

Application:

I,____________________________, having an interest in amateur radio, apply for membership in the Gadsden Amateur Radio Club and in support of my application, I enclose my dues of $20.00 for the calendar year of_________.

Signature:_____________________________

Date:________________________________