EDMOND AMATEUR RADIO SOCIETY
MEMBERSHIP APPLICATION

Please complete the entire form. Leave boxes blank that do not apply.
If printing and US Mail, send to: EARS, P.O. Box 48, Edmond, OK 73083

Membership Type: New Member Renewal

Name Callsign License Class

Address

City State (2-letter abbreviation ONLY) Zip

Home Phone Work/Other Phone Birthday

E-mail Address ARRL Member: Yes No

Annual Dues: Individual $25 Family (2 or more) $35 Student ($12.50)

*** Dues from 1 July to 30 September are half of the above applicable fee(s) (New Members Only) ***
**** It is the responsibility of the applicant to cover any returned check fees and charges ****

Scholarship Donation ($5.00 Suggested)

Total of Dues and Donation: Fill in if printing and US Mail

Family Member #1

Family Member Callsign

License Class     Birthdate

E-mail Address

Family Member #2

Family Member Callsign

License Class     Birthdate

E-mail Address


PARTICIPATION INTEREST
(Be Active – Check one or more activity)

PUBLIC SERVICE
INTRA-CLUB SERVICE

Weather Spotting

Communications (Parades, etc.)

Siren Tests

ARES Member

Licensed V.E.

Field Day Opr / Set-up

License Classes

>  

Your Privacy:
We appreciate your patronage and take your privacy very seriously. We do not sell information that you provide on this form to outside firms.

Previous versions of this form are obsolete after 30 Sept.

****************For Club Handling Only****************

Treasurer: Amt. Recd _____________ Ck/Cash/Paypal _____________ Date _____________

Secretary: Date Recd _____________ Roster Updated _____________ MC Updated _____________

   Ack Sent _____________ Payment: $ _____________   __Check  __Cash  __PayPal

   Funds to Treas: _____________