Yankee Amateur Radio Club Membership Application

Yankee Amateur Radio Club, INC.
Membership Application

DATE_______________

RENEWAL___NEW MEMBER____

FULL($20)___FAMILY($30)___ASSOCIATE (non-voting)($15)___

LAST NAME______________________________

FIRST NAME______________________________         CALL SIGN___________________

FIRST NAME______________________________         CALL SIGN___________________

FIRST NAME______________________________         CALL SIGN___________________

ADDRESS_______________________________________

CITY___________________        STATE_________         ZIP_______________

TELEPHONE________________________

EMAIL ADDRESS(ES)_____________________________________________________________________________________________

ARE YOU AN ARRL MEMBER? (The Yankee Club is an Affiliate Club)_________________

Please make your check payable to:

Yankee ARC, Inc.

Then mail the completed form with your enclosed check to:

MARTIN D ENGSTROM, JR

227 West Fryeburg Road

FRYEBURG ME 04037-9603