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.) ****************************************************** Request more information about SPARC membership and/or requirements: K3IR@ARRL.NET Callsign:_________________________________ ARRL Member?[ ] Other Organization Membership(s)_______________ _______________________________________________ License Expires:_____/_____/______ License Class:________________ Name:__________________________________________________ Address: ________________________________________________ City: ________________________State_______ Zip+4 ________________-__________ ****************************************************** 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.________ ****************************************************** 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:_________________________