BOSTON AMATEUR RADIO CLUB - 2012
Membership application  

New Renewal
Call Sign
Full Name
Name used on the air
Address
 
City
State
Zip + 9
Please include your area code
Evening Phone
Day Phone
Cell Phone
Email address
Needed to ensure delivery of The SPARC
License class
ARRL Membership
Completed ARRL EMCOMM classes None     Level 1     Level 2     Level 3
Completed ICS700? No     Yes
Are you an ARRL accredited VE? No     Yes

Roster Information: BARC periodically distributes the club roster to members only. Do you wish to omit the publication of your
Address     Evening phone

Select your membership category
Membership period is the calendar year. Dues are half price if joining between August 1 to October 31

Regular member $ 25.00
Junior member Are you under age 18? $ 12.50
Senior member Are you over age 65? $ 12.50
Family member Regular member you live with $ 12.50
If you are able, please give added support to the Club's activities and repeater. $
Pay electronically via Paypal or Print and mail the form with a check/money order
Comments
Signature