Anderson Repeater Club, Inc.

Application For Membership
 
Name _______________________________ Call ____________________

Address  _____________________________

City _________________________________ ZIP _____________________

Telephone Number _____________________

E-Mail Address ________________________

License Class __________________________ Expiration Date ____________

Date First Licensed _____________________  How long an FM’er? ________

Member of the ARRL? _________________

With this Application I apply for membership in the Anderson Repeater Club, Inc. I agree to abide by the Constitution and By-Laws of this organization and the FCC Rules and Regulations. I agree to operate in such a manner so as to bring credit to this organization and Amateur Radio in general and to actively participate in the Club.

_________________________________                           _____________________
Applicant’s Signature                                                                Date

Submit this application with a copy of your license (or show it to a member) to the Club Secretary:
                Anderson Repeater Club, Inc.
                PO Box 615
                Anderson, IN 46015

Dues Structure: Membership is $20 per year, prorated for new memberships at 10% per month
(Ap-$18, My-$16, Ju-$14, Jl-$12, Au-$10, Se-$8, Oc-$6, No-$4, De-$2).
Renewal of membership is $20 regardless of month paid.
Note: Licensed family members are included in membership (exclusive of voting).

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Credentials Committee Record:
Date Received ________________ Date of Membership Vote ________
Date Interviewed ______________ Approved ________
License Verified _______________ Rejected ________
Date Submitted to Club _________ Dues Received ________