Brainerd Area Amateur Radio Club MEMBERSHIP APPLICATION FORM Dues Year January 1, 2010, to December 31, 2010 ARRL Affiliated (Please submit one application for each person.) Name (First, MI, Last)______________________________________________________ Call Sign: _________________ Street Address:________________________________________________________ License Class: ________________ City: ________________________________________________________ State: __________ ZIP: _________________ Phone: (__________) __________-_______________ Additional Phone: (__________) __________-_______________ Date of application: ______________________________________ Check one: New application: _____ Renewal: _____ E-mail address: ___________________________________________________________ Member ARRL? ___________ I would like to receive the BAARC'er newsletter via the Internet______ via the US mail______ (Internet saves club money) Amateur Radio Interests: If there is a program you would like to see at an upcoming meeting, please indicate the topic and possible presenter. _______________________________________________________________________________ __________________________________________________________________________________________________ _ ________________________________________________________ The goal is to make Club meetings fun and informative. Check one: $20 Full Membership_________ $10 Additional Family Member________ $10 Student Member__________ Note: For first-time members, pay $5 per quarter for the time remaining in the year you join. Membership Dues $ ________________ Make checks payable to BAARC. Brainerd Area Amateur Radio Club $ Voluntary Contribution The club is a 501C3 non-profit Treasurer - Doug Bergsnev KD0ERE ______________ organization. Contributions are tax 15912 Olsen Lane $ deductible. Mail to: Brainerd, MN 56401 Total Enclosed ______________ I hereby make this application for membership in the BAARC and agree to abide by the Club By-Laws. Signature: ________________________________________________________________ Date: _____________________ Disclosure: With the data, the club can plan activities of interest to the majority of the members. This information will not be sold or given to another organization without express permission of the BAARC members. Please mail one form, along with dues, for each person who wants to be a club member.
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