Application for Membership in the
Southern Pennsylvania Amateur Radio Club, Inc. ( SPARC )

****************************************************** Membership Dues: $25.00 ($10.00 for other licensed member in the family). Please include a photocopy of your Amateur Radio license if new application or changes. Mail completed application along with dues and license copy to the club at: SPARC, Inc., P.O. Box 1033,  Lancaster,  PA  17608-1033  USA ****************************************************** Membership Type: Please check one. ____ New Regular Membership ____ Renewal Regular Membership                           ____ New Associate Membership (Amateur Radio license not needed.) ____ Renewal Associate Membership (Amateur Radio license not needed.) ******************************************************

Application in TEXT form available: CLICK HERE. Application in WORD form available:  CLICK HERE. Application in PDF form available: CLICK HERE. Request more information about SPARC membership and/or requirements: K3IR@ARRL.NET

 Callsign:_________________________________   ARRL Member?[         ]   Other Organization Membership(s), list below:

License Class_____________License Expires: _____/_____/______                

Name:__________________________________________________

Address: ________________________________________________

City: ________________________State_______

Zip+4 ________________-__________
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Optional Information
Leave an item blank if you do not want it on the club roster.

Date of Birth: _____/_____/______

Phone#: (____)-_____-_________    Alt.Phone#: (____)-_____-_________

Email adr(s): __________________________________

Male ____  Female ____                                               

Occupation: ________________________________
                                                    
Employer:__________________________________

Work Phone: (______)_____-_______ ext.________
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Give an honest estimate of your capability for supporting the club.
Please check one.
____ Dues-paying members-Cannot help with club events but will
     support the club with dues and extra donations
____ Semi-active member - Will attend events when I can.  
     Ask when you need help. May attend 1-5 meetings.
____ Active Member - Will help with many events and attend at
     least 6 club meetings this year.

Signature:_____________________________________________

Date:_________________________