RADIO AMATEURS OF SKAGIT COUNTY
PO BOX 814
Mount Vernon WA 98273-0814
Membership Application
Please Print Legibly
____ NEW MEMBER (Please attach copy of license) ____ RENEWAL ____ UPDATE INFORMATION
Name on License___________________________________________________________________________ Application Date___/___/___
Preferred Name ___________________________________
Call Sign ______________License Class ____________Expiration Date ___/___/___
Address _____________________________________________________________________ City _______________ State __ Zip ______
Home Telephone (____)_________________ Work telephone (____)____________________
Cellular/Pager (____)_____________________
E-mail: _________________________________________________________________________ ARRL Member ______ ( Y or N )
Family Membership:
Name ___________________________________________________________________ Call _______________License Class __________
Name ___________________________________________________________________ Call _______________License Class __________
Name ___________________________________________________________________ Call _______________License Class __________
Member Signature ________________________________________________________
Your preference in receiving the monthly club newsletter: ____Club Web Page w/email notification,
or____ USPO regular mail.
The club operates on a calendar year (January through December) with dues presently at $15 per year.
One dollar more for each additional licensed family member.
