Club Membership Appication Form by qvg16642


									                           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

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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