Greater Norwalk Amateur Radio Club

Membership and Renewal Application

Dues Schedule:

(Standard Membership) .............................................................$25 per year
(Student Membership) Individuals under 18 years of Age......$15 per year
(Family membership)..................................................................$25 per year

ð    Renewal

ð    New Member

Call Sign................... License Class................. Year First Licensed..........

Date of Birth............. What Bands do you operate?.................................

First Name.................. MI.......... Last Name...........................................

Street Address.................................................. City................................

State............. Zip............ Day Phone.............. Night Phone...............

Current Employer..........................................................................................

Other hobbies & interests?.............................................................................

I am enclosing payment in the amount of $.............. for the year 20......... as a

Standard......... Student.......... Senior......... Family Member..........

Please make checks payable to G.N.A.R.C.

Mail payment and this completed application form to:

Questions?