GCARA membership application and information update form


1. (___) I enclose $15 dues per club year (Jan. 1-Dec. 31) x (___) years = $______,

2 (___) I request free student membership (licensed Hams in grades 1-12) for Jan. 1-Dec. 31.
If a free Student Membership, what is your school & grade?
________________________


This is a (___) new, (___) renewed membership. Member of ARRL? (___) yes, (___) no.

(___) My yearly dues are paid. Please enter the following changes for me:

NAME CALL______________________________________CALL______________________

ADDRESS* _________________________________________________________________

CITY/STATE*________________________________________________________________

ZIP* Tel. No. with A/C* , (_____)_____ - ________

E-MAIL ADDRESS*______________@___________________________


My interests in and out of Ham radio: ___ Public service; ___ Working with youngsters;
___ On-air operations; ___ VHF/UHF; ___ HF; ___ Building; ___ Teaching; ___ Computers;
___ Helping people become licensed; ___ Repairing equipment; ___ Helping other Hams.


*Provide specified information only if it has changed since last renewal.

Mail with dues payment - $15.00 to:


Richard Pestinger, KC8RP
66 Boehm Ct
Fairfield, Ohio 45014

Make checks/MOs payable to GCARA.

If you would like your membership card mailed to you, please send a SASE with your application

REV: October 28, 2010