Milwaukee Repeater Club Membership Application

Type of Application ____ New Member ____ Renewal

Type of Membership ____ Individual ____ Family

(If Family: Please list the names, calls and other pertinent information on any family members living at the same address who are Hams and desire to become MRC members. The $20.00 dues payment covers an entire family for MRC membership.)

NAME(s)__________________________________________ CALL SIGN(s) ___________________

NAME(s) YOU USE ON THE AIR _______________________________________________________

STREET ___________________________________________________________________________

CITY _____________________________________________ STATE ________ ZIP ____________

HOME PHONE #: _________________________ WORK (optional) __________________________

CELL (optional) _________________________ BIRTH DATE (optional) __________________

CLASS OF LICENSE _________________________ EXPIRATION DATE _______________________

PLEASE NOTE! If there is ANY personal information that you DO NOT wish to be published into the club roster, please note it on this form.

EMAIL ADDRESS (for newsletter notification) ______________________________________

Please indicate if you would you like the Club Newsletter delivered by ____ e-mail (free of charge) or ____ U.S. Mail (additional $5 per year)?

Are you currently an ARRL member? YES ______ NO ______

DUES:
NEW MEMBERS - January thru December $20.00 $ ________________
NEW MEMBERS – After July 1 $10.00 $ ________________
ANNUAL RENEWAL - $20.00 $ ________________
NEWSLETTER POSTAGE ASSESSMENT - $5.00 $ ________________
MRC COFFEE MUG # OF CUPS _____ x $5.00 = $ ________________
MRC NAMETAG w/MRC LOGO # OF NAMETAGS _____ x $7.50 = $ ________________
DONATION TO MRC CAPITAL IMPROVEMENT FUND (tax deductible) $ ________________

TOTAL AMOUNT ENCLOSED $ ________________

Send check payable to 'Milwaukee Repeater Club' at the address below:

THE MILWAUKEE REPEATER CLUB, INC.
P.O. BOX 2123
MILWAUKEE, WI 53201

I hereby agree to abide by the Constitution, by-laws and rules of the Milwaukee Repeater Club.

(Signed) ____________________________________ Date ______________

Your membership will be voted on at the next membership meeting once the application is received.

THANK YOU FOR SUPPORTING THE MILWAUKEE REPEATER CLUB!