Anderson Repeater Club, Inc.

Application For Membership

Name _______________________________ Call ____________________ Address  _____________________________ City _________________________________ ZIP _____________________ Telephone Number _____________________ E-Mail Address ________________________ License Class __________________________ Expiration Date ____________ Date First Licensed _____________________  How long an FM’er? ________ Member of the ARRL? _________________ With this Application I apply for membership in the Anderson Repeater Club, Inc. I agree to abide by the Constitution and By-Laws of this organization and the FCC Rules and Regulations. I agree to operate in such a manner so as to bring credit to this organization and Amateur Radio in general and to actively participate in the Club. _________________________________                           _____________________ Applicant’s Signature                                                                Date Submit this application with a copy of your license (or show it to a member) to the Club Secretary:                 Anderson Repeater Club, Inc.                 PO Box 615                 Anderson, IN 46015 Dues Structure: Membership is $20 per year, prorated for new memberships at 10% per month (Ap-$18, My-$16, Ju-$14, Jl-$12, Au-$10, Se-$8, Oc-$6, No-$4, De-$2). Renewal of membership is $20 regardless of month paid. Note: Licensed family members are included in membership (exclusive of voting). - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Credentials Committee Record: Date Received ________________ Date of Membership Vote ________ Date Interviewed ______________ Approved ________ License Verified _______________ Rejected ________ Date Submitted to Club _________ Dues Received ________