Application for Membership
W4VIY
Milton Amateur Radio Club, Inc
P.O. Box 4072
Milton, Florida 32572
Name:_________________________________ License Class:__________________
Call Sign:____________________
Expiration Date of Call:___________________ Mailing Address:_______________________________________________________ City:_________________________ State:_______ Zip Code:__________________ E-Mail Address:________________________________________________________ Home Phone #:______________________ Cell Phone #:_______________________ Current Member of ARRL for 2010: ________ Yes or No ________
Check modes and bands and how power wise you can operate. Mode
HF 50 MHz 144 MHz 222 MHz 440 MHz Others SSB CW FM PSK-31 PACKET SSTV SSTV Dig Base AC Base DC Mobile DC Portable Signature:____________________________________ Date:_____________________ Make check to MARC for $ 15.00 for dues, send to Post Office box listed at top of page.