Application for Membership in the 
Southern Pennsylvania Amateur Radio Club, Inc.(SPARC)
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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
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Membership Type: Please check one.
____ New Regular Membership
____ Renewal Regular Membership                          
____ New Associate Membership
____ Renewal Associate Membership
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Callsign:_________________________________ 

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#: (____)-_____-_________ 

email: __________________________________ 

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:_______________________________