Date ____________________
 
Name ________________________________

Call ______________   License Class ________________
 
Address __________________________________

City __________________ State ______ Zip ________
 
Home phone ___________________________

Work phone ____________________________

Cell phone _____________________________
 
E-mail ____________________________________
 
ARRL member (Yes/No)? ____________
 
New member? ___________ Renewal? __________
 
Exclude your info from printed club membership roster? Yes ______ No _______
 
Dues information:
 
Full year $18.00 or if under age 18 - $6

Family membership: Each additional family member is charged the under 18 age rate.
 
Please make checks payable to SFVARC.
 
Mail this form and your dues to:

San Fernando Valley ARC
P.O. Box 280244
Northridge, CA 91328-0244  
Thank you for your interest and participation in the SFVARC.