MEMBERSHIP APPLICATION FOR PUEBLO HAM CLUB INC.
Print application, fill out and bring to meeting, or mail to:   Pueblo Ham Club Inc. P.O. Box 92, Pueblo, CO 81002

 

Date:_____________ ARRL Member?________ New Member or Renewal?_________________

Name:_________________________________________

Street Address:________________________________________________

City:________________________State:____________ZIP:________________


Callsign:________________ License Class:______________________

Home Phone:_________________ Cell Phone:__________________ Work Phone:_________________

Email Address: __________________________________


Additional Family Members to Join or Renew

Name:_____________________ Callsign: _______________ License Class:__________________

Name:_____________________ Callsign: _______________ License Class:__________________

Name:_____________________ Callsign: _______________ License Class:__________________


Would you like your Gridleak newsletter to be delivered by email or regular mail?_______________

Dues (per year): Full Member $20, Senior (60 +) $15, Associate $15, Family $30
Senior Family $22.50, Student $15

Make checks payable to “PHC”