Application for General Membership
Southern Pennsylvania Amateur Radio Club, Inc. P.O. Box 1033, Lancaster, PA 17608-1033 Current Membership Dues: $25.00 ($10.00 for other licensed member in the family) Please include a photocopy of your Amateur Radio license if new application or changes Year: Member Type: License Class:
O 2001 O New Associate Membership O Novice O General O 2002 O New Regular Membership O No-code tech O Advanced O 2003 O Renewal Associate Membership O Tech plus O Extra O 2004 O Renewal Regular Membership Callsign:_________________________________ License Expires: _____/_____/______ Name:___________________________________ Birth Date: _____/______/_________ Address: _________________________________ O Male O Female Age:________ City: ________________________State________ Current Speed Dial Slot#:_______ (If already assigned) Zip + 4"________________-__________ Speed Dial Phone#: _____-_______ Township: ________________________________ Other Amateur Radio Memberships (If not in town) O Red Rose O AARL O Ephrata County:___________________________________ O Lebanon O LRTS O SVRA O Red Lion O AARG O CPRA Phone: (______) _______-____________________ O Ephrata O Other___________
O Unlisted O Do not publish in club roster RACES participation: Occupation: ________________________________ O Current card-carrying member O Would like information Employer:__________________________________ O Not interested at this time Work Phone: (______)_____-_______ ext.________ Band Capabilities: HT Mobile Base 2 meters O O O Give an honest estimate of your capability 440 mhz O O O for supporting the club in the following year. 2m/440 Cross-band O O O O Dues-paying members-Cannot help with club events but will support the club with dues and extra donations O Semi-active member - Will attend events when I can. Ask when you need help. May attend 1-5 meetings. O Active Member - Will help with many events and attend at least 6 club meetings this year. DIGITAL COMMUNICATIONS E-MAIL CAPABILITIES TO RECEIVE CLUB NOTICES Check if you have: O I currently have full Internet access including E-mail O Computer_____________ O I currently have JUNO E-mail access O Microsoft Windows ________ O I would like a copy of JUNO to receive club -Email FREE O Modem? Speed _________Baud O Packet Station, Full or Part-time Primary E-mail address: __________________________________ (For Club mailings) PLEASE fill out this form completely Secondary E-mail Address: _______________________________
and sign and date below
Signature:________________________________________ Date:_______________________________
Amateur Radio Operating Capabilities Band CW SSB FM Packet Base Mobile HT ____________________________________________________________ 160 meter [ ] [ ] [ ] [ ] [ ] [ ] [ ] 80 meter [ ] [ ] [ ] [ ] [ ] [ ] [ ] 40 meter [ ] [ ] [ ] [ ] [ ] [ ] [ ] 30 meter [ ] [ ] [ ] [ ] [ ] [ ] [ ] 20 meter [ ] [ ] [ ] [ ] [ ] [ ] [ ] 15 meter [ ] [ ] [ ] [ ] [ ] [ ] [ ] 12 meter [ ] [ ] [ ] [ ] [ ] [ ] [ ] 10 meter [ ] [ ] [ ] [ ] [ ] [ ] [ ] 6 meter [ ] [ ] [ ] [ ] [ ] [ ] [ ] 2 meter [ ] [ ] [ ] [ ] [ ] [ ] [ ] 220 Mhz [ ] [ ] [ ] [ ] [ ] [ ] [ ] 440 Mhz [ ] [ ] [ ] [ ] [ ] [ ] [ ] 902 Mhz [ ] [ ] [ ] [ ] [ ] [ ] [ ] 1.2 Ghz [ ] [ ] [ ] [ ] [ ] [ ] [ ] Do you have a 2m/440Mhz Dual Band radio with Crossband Repeat function: YES [ ] NO [ ] If yes: Base [ ] Mobile [ ] HT [ ] Do you have any handicaps which would require special consideration during your volunteer work as a SPARC Inc. volunteer? YES [ ] NO [ ] If yes, please list and indicate any required special considerations. ______________________________________________________________________________ ______________________________________________________________________________ Do you own a 4x4 vehicle? If yes, make and model ____________________________ Do you own a snowmobile: YES [ ] NO [ ] Do you own boat: YES [ ] NO [ ] If yes, size and capacity:_________________ In an emergency situation, is snowmobile and boat available: YES [ ] NO [ ]