Membership form

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Membership Type *

• New Member
• Renewal

(required)

Multiple Choice *

• Individual Membership
• Family Membership

(required)

Are you an A.R.R.L. member?? *

• yes
• no

(required)

Name *

(required)

Callsign *

What is your Amateur Radio and/or GMRS Callsign?? (required)

Your current License Class *

• Novice
• Technician
• General
• Advanced
• Extra
• GMRS

(required)

Email *

(required)

- Phone provide

Your mailing address *

(required)

City & State *

(required)

Postal Zip Code *

(required)

Phone number - Home *

(required)

Phone number - Cell

Are you a year round resident?? *

• Yes
• No

(required)

If no please provide your temporary Florida address ( Street ,city, State, Zip )

Place a check in the box below If you do not want your information printed on the club roster. The default is YES the items will be printed on the roster.

• NO Mailing address
• NO Telephone number
• NO Email address

Married ??

• Yes
• No

Spouses Name? ( or significant other )

Spouses CALLSIGN

Spouse License Class

Your Birthday

(Optional)

Spouse Birthday

(Optional)

Special Interests or hobbies?

Any comments or questions?

Submit

$20 Must be received by December 31st to maintain your club membership.

How to pay the dues:

• Come to a club meeting.
• Mail in the completed membership form with a check to:
  SpringHill Amateur Radio Club
  P O Box 6083
  SpringHill, Fl 34611
• Use the PayPal option on this page.
  (coming soon)