Name: _______________________ Call Sign:________ Date:_________Are You A Member Of The ARRL?_______

Phone:_____________Would You Like Your Phone Number Listed In The Members List? Yes______ No_______

Web Site:http://www.______________________________

E-mail:________________________

Street:_____________________City:______________Zip:__________

Newly Licenced Amatures Within The Year?____________

new:$20.00/Year/Family___________

Renewal:$20.00/Year________

Student:$5.00/Year_______________

Ham Interest:___________________________

PLEASE make check payable to: C.A.R.A.(Thank You - Pat, kc2awa) Mail TO: Pat Belcher 880 Middle Rd. Horseheads,N.Y.14845

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last modified on 11/08/01