APPLICATION FOR MEMBERSHIP

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On Line Application - William Freeman KC2NWU - membership chairman
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* Name:	Nick Name:
Call Sign		Lic. Class:
* Address:
* City:		* State:	* Zip:
* County:
Birth Date:
Spouses Name:		Spouses Call:
* Date of Application
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Membership you are applying for:
Select only one...
Regular. $30 All club privileges, functions, facilities, voting rights, elected offices/committees
Family $40 Same privileges as regular plus allows family members to participate
Student $15 17 years of age or under / not eligible to vote or hold office
Patron $20 Individual or organization / not eligible to vote or hold office
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Family membership only : List Family members residing at your residence.
Name		Call
Name		Call
Name		Call
Name		Call
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Contact Information:
* Phone (home)		* Phone (cell)
Phone (work)
* * * Email Address
Emergency Contact Phone:

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Survey:
How did you hear about our club?
Would you be willing to help on Committees? Yes
Would you be willing to help at club events? Yes
List any other radio clubs you currently belong to:
List positions if any do you hold at the other club/s


Are you a current ARRL member? yes
List any ARES or RACES groups you currently belong to




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Note: Submit dues payment to the membership chairman, either by mail or in person
* Checks payable to: Lancaster Amateur Radio Club
* Mail to: Lancaster Amateur Radio Club 525 Pavement Rd, Lancaster, NY 14086
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Activities and/or Committees you are interested in:

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Comments or Questions:
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* I will Mail my dues yes	* I will submit dues in person yes
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*		Thank You !
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You will be contacted by phone or email from the Membership Chairman, Bill Freeman KC2NWU confirming the receipt of your application.
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All applications for membership shall be submitted at the next Board of Directors meeting. All applications will be reviewed by the Board and upon approval shall be voted into membership. All applicants must express a willingness to abide by the Constitution and By Laws of the Lancaster Amateur Radio Club, Inc.