Atascosa County Amateur Radio Club
______ New Member: Please complete both pages and sign 1st page
______ Renew Membership: Only need to update information
Name: Birthdate:
Address:
City: State: Zip:
E-Mail Address:
Home Phone: Cell Phone: Work Phone:
Call Sign: License Class: Expiration Date:
Vanity? Yes No Member of the American Radio Relay League (ARRL)? Yes No
Spouse's Information
Name: Birthdate:
E-Mail Address:
Home Phone: Cell Phone: Work Phone:
Call Sign: License Class: Expiration Date:
Vanity? Yes No Member of the American Radio Relay League (ARRL)? Yes No
Family Members
Name Relationship DOB Call Sign ARRL Y/N
Individual Membership with voting privileges: A Licensed Amateur Radio Operator $15.00
Associate Membership: A person applying for membership who is NOT a Licensed $15.00
Amateur Radio Operator.
Family Membership: All family members must live in the same household. $25.00
In signing this application, I agree to adhere to the rules governing a Licensed Amateur Radio Operator, to abide by the
by-laws of this organization and to adhere to proper repeater protocol. I understand, that in order to be a voting
member, I must be an Amateur Radio Operator licensed with the Federal Communications Commission.
Signature: Date:
Spouse's Signature: Date:
Submit dues and attach a copy of your current FCC License and a copy of current ARRL membership card.
www.wa5ar.org
Training information
Persons Name Course Taken Date Taken
Special Interest
2-meters Emergency Power Leadership
2-meters SSB Field day Rabbit Hunting
4 wheel drive vehicle Fundraising Repeaters
70 cm Generator Special Events
Airmail HF VE Testing
Antennas HF - Fixed VHF/UHF
APRS HF - Mobile VHF/UHF Fixed
ARES/RACES HF - Portable VHF/UHF Mobile
DX Home brewing VHF/UHF Portable
Other: ____________________________________________________ Winlink/Telpac Capab
Volunteer Examiner (VE)? Group:
Member of MARS? If yes, give: Call: Service
Member of ARES? If yes, give: County(s)_____________________________ Title if any: __________________
Member of RACES? _____Yes _____No Member of Skywarn? _____Yes _____No
BRING COMPLETED FORM AND ATTACHMENTS TO AN ACARC MEETING OR MAIL TO THE ADDRESS BELOW:
Atascosa Co. Amateur Radio Club
PO Box 647
Pleasanton, TX 78064-0647