Indian River Amateur Radio Club Membership Application

Last Name
First Name
Middle Initial
Call Sign
Street
City
Home State
Zip
Date of Birth
Home Phone
Work Phone
Spouse
Occupation
Email Address
License Class
Years Licensed
Expiration Date

Membership Classification Requested

General Member	$20.00 Due January 1 each year
Family Member	$10.00 Due January 1 each year
Associate Member	$8.00 Due January 1 each year

Membership Clasifications

General - Must hold a current Novice class or higher Amateur Radio License

Family - Must hold a current Novice class or higher Amateur Radio License and reside at the same postal address as a General member

Associate - Must have a demonstrated interest in the Amateur Radio Service without an Amateur Radio License

Annual dues for those joining after January of the current membership year will be pro-rated in accordance with the number of months remaining in that year