P.O. BOX 1282 STONE MOUNTAIN, GA 30086-1282

APPLICATION FOR MEMBERSHIP

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Please select the appropriate application type:

First Name: Last Name: Middle Initial:

Preferred Name: Amateur Call: Expires:

Select License Class:    E-Mail Address:

Address :      City:

State: Zip+4:       Birthdate :   (Enter as MM/DD/YYYY)

Telephone: Home:     Check if Unlisted     Cell:     Work:     Ext.

Occupation:

Are you a Member of the ARRL?   Check if Yes    If Yes, give Expiration Date:

Please Select type of Membership:

Additional Family Members:
Name  -   Birthdate   -   Callsign   -   License Class   -   FCC Expires   -   ARRL Expires

I hereby apply for membership in the Alford Memorial Radio Club, Inc.  In making this application, I pledge to operate
in accordance with the Club rules and the FCC rules and regulations (Part 97) governing the Amateur Radio Service and
my equipment.  In addition, I pledge to use only good operating techniques on the Club's repeaters and will not tie up
the repeaters when there are others waiting to use them, or when Simplex communications are possible.

Signature: Date:
                   (Name and Date entered signify legal digital signature)


Comments for the Membership Chairman:


               


For more Information E-Mail:   Membership Chairman


Last updated 04/30/2016
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