Membership Application
                                             Mountain Amateur Radio Club
                                P.O. Box 1012, Woodland Park, CO. 80866-1012

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Date:_______________                                                   New Application:_______ Renewal:_______

Name:__________________________________           Callsign:____________

License Class:_____________                                          Expires:____________

Street Address:_______________________________________ P.O. Box:_____________

City, State, Zip+4:__________________________________________________________

Telephone:

Home:_________________ Work:______________ Cell:______________ Pager:_____________

E-mail Address:_________________________________________

Spouse Name:_______________________________

Member of:

ARES:________ ARRL:________ SKYWARN:________ Teller County SAR:________

Other(s) in family licensed (name, callsign, relationship and living at your residence):

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What equipment, modes, and bands can you operate from your fixed station?

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What equipment can you operate mobile?

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Can we call you for public service and emergency call out?____________

Any other pertinent information?

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