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):
__________________________________________________________________
__________________________________________________________________
What equipment, modes, and bands can you operate from your fixed station?
__________________________________________________________________
__________________________________________________________________
What equipment can you operate mobile?
__________________________________________________________________
Can we call you for public service and emergency call out?____________
Any other pertinent information?
__________________________________________________________________