Print this page, it's the membership application form. Bring it to a meeting ( 1st and 3rd Thursday of each month at 7:30 PM ), or mail to PARC, P.O. Box 873, Fort Walton Beach FL 32549.

PARC Membership Application

I hereby apply for membership in the Playground Amateur Radio Club. I agree to abide by the Constitution, By-laws, Policies, and Procedures as established by the Club.

 

Full Name: ____________________________________________

Amateur Call Sign: ____________________________________

License Class: ________________________________________

Home Address: _________________________________________

City: ________________________________ State: _______________ Zip: ___________

Home Phone: _______-______-________

Work Phone: ________-________-_______

E-Mail: ___________@___________________________________

I am applying for full membership and am remitting $20.00 annual dues with this application, or the amount will be pro-rated at $1.50 per month.

As a new licensee, I am applying for one year of free membership _________________

As a Non-licensee, I am applying for non-voting membership and am remitting $10.00 annual dues with this application, or the amount will be pro-rated at $0.50 per month.

A copy of my FCC License is attached, per section 13, by-laws, September 1, 1980.

 

 

Signature ________________________________________