“ON STATION” Amateur Radio Club
Membership Application / Renewal
 

For Year:  __________  New Application:  ___  Renewal:  ___
Your OSARC Membership #____-____  (If Applicable)
Please Note:  Your membership number and card are permanent.  If you lose your card, Please contact the club Secretary to secure a new card.
 
Name_______________________________ Call Sign_____________
Mailing Address ___________________________________________
City ________________________________State ____ Zip ________
Phone (H) (___) ____________(W) (___) ____________
OK to publish phone number in Member Directory?  Yes   No
E-MAIL _________________________________________
OK to publish E-Mail address in Member Directory?  Yes   No
License Class_____________________ CW @ _____ WPM
ARRL Member?  Yes   No
Age if under 18: ___ (Parental permission may be required to participate in certain events.)

Membership Class
____ Regular Member (Licensed Ham w/ Voting Privileges) $12.00 Yr.
____ Associate Member (Un-Licensed Person)                    $  6.00 Yr.
____ Life Member (Licensed Ham w/ Voting Privileges)

The membership year begins March 1.  We do not accept more than 1 years dues at a time.  Please send your Check or Money Order payable to Dave Farren, to:  OSARC 175 S. Bishop Ave #4  Secane, PA.  19018 or bring your payment to an OSARC Meeting.

Signature______________________ Date ___________

Areas of Interest  (Please Specify or Update)

____ I Would like to be an LV 87 AMBROSE Radio Operator.
____ Participate in OSARC Expeditions to “Activate Lights”.
____ “ON STATION” Home Base Station Operator during AMBROSE/OSARC events.
____ Participate in ARLSH Activities that coincide with OSARC activities.
____ Traffic Handling
____ Help Teach & Mentor fellow OSARC members in:  CW   License   Traffic   Radio
____ Other - Please Specify: __________________________________________
 
Administrative Use only:
  Date Application Received:  ____________
  Membership Number Assigned:  ____-____  Date Card Sent:  ____________