Mount Vernon Amateur Radio Club

Membership Application
Last Updated: 30 June 2003
Name Information:
First Name:   Last Name:   MI:  
Type Membership:      
Callsign Information:
Call Sign: License Class: Year First Licensed:
Are you an ARRL Member: ARES Member: If not ARES - Receive Info?:
Contact Information:
Street Addr:   Address 2:
             City:    
           State:      Zip Code:  
 Home Phone:            Email:  
Spouse (Significant Other) Information:
Spouse's Name:             Spouse's Call:  
    License Class:     Year First Licensed:  
Bands you like to operate (check all that apply):
160:   80:   40:   30:   20:   17:   15:  
12:   10:   6:   2:   1.25:   0.70:   Higher:  
Modes that you like to operate (check all that apply):
SSB:   FM:   AM:   CW:   Digital HF:  
Digital VHF:   ATV:   SSTV:   Satellite:    
Your interests (check all that apply):
Public Service:   DXing:   Contesting:  
QRP:   Homebrewing:   Building Antennas:  

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