B.R.A.R.S. Member Application Form
Blue Ridge Amateur Radio Society Inc.
CARD Number:
(For Club Use Only)
PO Box 6751
Note:
Please include a self photo for the roster and your photo Id card if you have one. If you would like your Id card laminated, please include your signature on a blank white index card.
Greenville SC 29606
http://www.brars.org
Name:
Initial:
Last:
Call:
Name you use on the radio:
Mailing Address Information:
Street1:
City:
Street2:
State:
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
D.C.
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Phone Numbers and eMail Information:
Home:
Work:
Mobile:
Pager:
Email:
FCC License / ARRL / Birthday Information:
Class:
Select Class
Tech
Tech Plus
General
Advanced
Amateur Extra
Expiration Date:
ARRL Member:
Yes
No
Birthday:
Application Type Information:
$20.00 Full Member
$15.00 Full Member (over 65)
$10.00 Family Member
$10.00 Associate Member
If accepted, I agree to abide by the Constitution and By-Laws of the Blue Ridge Amateur Radio Society. You will need to sign here when voted into the club.
Signature:
Sponsors: (Two BRARS Club Members):
Call:
Name:
Call:
Name:
For Club Records:
Date:
Secretary:
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