Membership Form

* = required field

* Name:

* Address:

* City:

* State:

* Zipcode:

* Phone Number:

* Email:

Call Sign:

License Class: TechnicianGeneralExtraOther

Have you been a member in the past? YesNo

If yes, what years?

Is your FCC information up to date and current? YesNo

Are you a Volunteer Examiner (VE)? YesNo

Who are your credentials sponsored by?

If you are a VE, are you interested in Club sponsored VE sessions? YesNo

Do you or have you used our W4CUL Repeater? YesNo

Do you have HF capabilities? YesNo

Please let us know about your station setup and modes you operate:

What area of the hobby would you like to learn about?

What is your area(s) of expertise when it comes to Amateur Radio?

Are you currently an ARRL Member? YesNo

Current ARRL Member Number:

Expiration Date?

Any Questions/Comments?

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