Application for MTARS Membership

Membership year: ___________; Today’s Date:________ Office use

________

Dues for membership in the Middle Tennessee Amateur Radio ________

Society are: ________

(1) $20 per year for Regular (voting) members ________

(2) $20 per year for Associate (non-voting or not licensed) ________

(3) Free for Junior (under age 17, non-voting members) ________

An amateur license is required ONLY for regular, voting members. ________

________

Print and fill out this application and mail it along with a ________

Check in the proper amount to: ________

MTARS

P.O. Box 932

Tullahoma, TN 37388-0932

Last name:___________________________________________

First name:___________________________________________

Call sign:______________ Class of license:________________

Home telephone: (____)_____-_______ Cell: (____)_____-_______

E-mail address:_______________________________________

List on club web site? E-mail: Yes ( ) No ( ) Your Pic: Yes ( ) No: ( )

Street address:________________________________________

City: ______________________________State: ___ Zip:________

County of residence:_____________DOB:___________mm/dd/yy

Type of Membership Requesting? (please check)

Regular:_____ Associate:_____ Junior:______

Are you a member of ARRL? Yes ( ) No ( ) Life ( )

Are you an A.R.E.S member? Yes ( ) No ( )

Rev: 5 09/18/2016