Holmesburg Amateur Radio Club 3341 Sheffield Ave. Philadelphia, PA. 19136 Please Print or Type. ARRL members please list your name and address as shown on your Qst mailing label._____New_____Renewal. Name : ________________________________________________________________ Call : ________________________________________________________________ Class : _______________________________________________________________ Phone : __________________________ Address : _____________________________________________________________ City : _______________________________________________ State : __________________________ Zip : ____________________________ EMail Address: _________________________________________ Are you willing to receive the newsletter as an Adobe Acrobat (pdf) file? _____ Y/N May we list your phone number in our club directory?____Yes ____No. Do you own Mobile Gear? H.F.____Yes____No VHF____Yes____No. Do you own Hand Held gear?____Yes____No. Are you on 0 - 30 Mhz ___AM___FM___CW___SSB___RTTY___PACKET 30 Mhz and above___AM___FM___CW___SSB___PACKET Interested in__Field Day__Contests__Nets__CW Practice__Theory__Other Are you a member of the ARRL___Yes___No___Expires__________ Please include a Photo Copy of your license if you have one. ----------------------------------------------------------------------------- I agree to abide by the rules and regulations of the FCC and the Holmesburg Amateur Radio Club, Inc. and to use the repeater with legal and proper amateur radio practices. Signature: __________________________________________ Date:__________________ _____________________________________________________________________________ _____________________________________________________________________________ Initiation and Dues New and Current Members $20.00 per Year Initiation Fee (a one time charge) $10.00 Initiation Fee waived for Family members. _____________________________________________________________________________ _____________________________________________________________________________ Enter Other Family Members Calls_____________________________________________ Prorate Dues New Members ONLY : If you Join Between these Dates Pay ------------------------------------------------ Jan 1st -- $20.00, From April 1st -- $15.00, ------------------------------------------------ From July 1st -- $10.00, From Sept. -- 1st $5.00 New Member $20.00 One Time Initiation $10.00 Total Included__________________ Make checks payable to : H.A.R.C. Inc. Mail them to : H.A.R.C. 3341 Sheffield Ave Philadelphia, PA. 19136