First Name Middle by Abby McCary


									                                  New Jersey Institute of Technology
                                      Amateur Radio Club, K2MFF
                                            416 Faculty Hall
                                    (973) 596-3505 /

                                    APPLICATION FOR MEMBERSHIP

First Name:_______________________________ Middle: _______________Last:____________________________

Address: Street:______________________________________________ City:_______________________________

State:____ Zip Code: ____________ NJIT-ID # (For ENROLLED Students ONLY):__________________________

Telephone:    Home: (       ) _____________________ Work: (            ) ___________________________________

E-mail Address: _______________________________________________________________

Personal Web Page: ____________________________________________________________

Major: _____________________________________ (Please Circle One):             Undergraduate        Graduate

License Class Currently Held: (Please Circle One)

Extra        General        Technician (w/ Code)        Technician (No-Code)       Non-Licensed

Call Sign: __________________________________ Year Licensed: __________________________________

How did you find out about our club? (Please check all that apply)

_____ Fellow Student            _____ On Campus Info Meeting           ____ Our Web Page
_____ Our Bulletin Board        _____ Our Newsletter                   ____ The Vector
_____ Our Repeater
_____ Executive Board Member (Please State Whom): __________________________

_____ Other (Please Specify): __________________________________

                                                                                                 (Please Circle One)
Would you like to borrow any manuals on how to become an amateur radio operator?                 YES              NO

Would you be interested in serving in one of the following committees? (Check all that Apply)

_____ Executive Board              _____ NJIT Student Senate Liaison           _____ Web Page Administration
_____ Public Relations             _____ Amateur Radio Activities & Events

_____ Amateur Radio Equipment Maintenance Person**
      (**Head of Maintenance must hold a General Amateur License)

Membership to the NJIT Amateur Radio Club, K2MFF, is open to NJIT Alumni, current NJIT students, faculty, and
administration. Club membership can be granted to student without an amateur radio license so long as they are actively
seeking to obtain such a license through the help of the NJIT Amateur Radio Club, K2MFF.

Signature: ___________________________________________________             Date: ___________________________

JMS (KC2OSZ) 9 / 07                                                APPROVAL DATE: ___________________
AWM (K2HAV) 9 / 07 President Signature:______________________ V.P. Signature: _____________________


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