MEMBERSHIP APPLICATION

To join the SWMS ARC, just print out a copy of this form and bring it to the next club meeting. Check W5WQ.net for location and time of next meeting.

Click for PDF Version
 

SMARC, INC.

SOUTHWEST MISSISSIPPI AMATEUR RADIO CLUB

NEW MEMBER___ RENEWAL___ UPDATE___ DATE_______

NAME_________________________________CALLSIGN______________

ADDRESS____________________________CITY________________STATE &ZIP______

PHONE: HOME____________________WORK_____________CELL_____________

 EMAIL______________________LICENSE CLASS_____________________

Please circle the activities you are interested in:

HF VHF/UHF PACKET ATV DX OSCAR ARES

EMERGENCY ARES RACES SKYWARN HAMFEST FIELD DAY SPECIAL EVENT

 OTHER_________________________________________________________________

Station Capabilities: Circle all applicable items and fill in blanks:

HF 2 meters 220 band 440 band

 Satellite Mobile bands_________________Emergency AC Power________

Other Capabilities_________________________

Are you a member: ARRL_____ RACES______ ARES____ AMSAT____ MARS____

10-10 INT____

Would you serve as: Club officer____Club net controller____Committee
Chairperson_______

 

DUES: Payable annually by Jan 15th

Member------$24.00 Family member--$12.00 High school student-$12.00



Family member
Name_________________Callsign_________Class__________

In same household
Name_________________Callsign_________Class__________

 
Name_________________Callsign_________Class__________

$__________Total dues

 

OATH

I agree to abide by the constitution and by-laws of the club, ARRL and FCC.

 Applicant Signature_________________________________Date____________

Recommended by___________________________________Date___________

Comments__________________________________________________________