ROME RADIO CLUB
APPLICATION/RENEWAL MEMBERSHIP FORM
Addl. Mbr. Name:_________________________________Callsign:____________
Address:_______________________________________________________________
City:________________________________State:________Zip Code:__________
Phone: (____)_____-__________ Amateur Class:________ Addl Mbr:________
Month/Day of Birth: _____/_____, Addl. Member: _____/_____
E-mail Address:_____________________________________________
Are you a member of:
American Radio Relay League (ARRL): Yes____ N0____
Amateur Radio Emergency Service (ARES): Yes____ N0____
Radio Amateur Civil Emergency Service (RACES): Yes____ N0____
Another Amateur Radio Club(s) Yes____ N0____
If Yes, Please List________________________________________________
Renewal [ ] New Member [ ] Life Member [ ] Application Date:______
I, the undersigned, hereby agree to abide by the Constitution and By-laws, as well as all other rules of the Rome Radio Club, Inc.
Signature:_____________________________________________________________
Interest and Capabilities Survey:
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HF (160m-10m): |
CW [ ] |
SSB [ ] |
FM [ ] |
Digital [ ] |
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VHF (6m - 1.25m): |
CW [ ] |
SSB [ ] |
FM [ ] |
Digital [ ] |
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UHF (70cm and above): |
CW [ ] |
SSB [ ] |
FM [ ] |
Digital [ ] |
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[ ] Traffic |
[ ] Packet |
[ ] Satellites |
[ ] RTTY |
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[ ] EME |
[ ] Ragchews |
[ ] APRS |
[ ] Antennas |
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[ ] QRP |
[ ] CW |
[ ] Phone |
[ ] Experimenting |
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[ ] Field Day |
[ ] Contesting |
[ ] DX |
[ ] Public Service |
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[ ] SSTV |
[ ] ATV |
[ ] Other_______ |
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Print and mail to: |
Joan Effland KA2TSC
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Dues are $10/year, additional family members are $5/year.
Make Checks Payable to: Rome Radio Club, Inc.