GCARA membership application and information update form


1. (___) I enclose $15 dues (add $5.00 for hard copy of The Mike and Key newsletter) 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 ($20.00) to:


David Self, K8SSN
3261 Old Oxford Rd
Hamilton, Ohio
45013

Make checks/MOs payable to GCARA.