GM AMATEUR RADIO CLUB MEMBERSHIP APPLICATION

Membership in the GM Amateur Radio Club is open to anyone interested in Amateur Radio

NEW MEMBER [ ] RENEWAL [ ] REINSTATEMENT [ ]

PLEASE PRINT OR TYPE: ARRL MEMBER YES________ NO_________

PRESENT CALL _______________________

NAME ___________________________________________________________________ DOB_______________

I WOULD LIKE TO BE CALLED__________________________________________

HOME ADDRESS _______________________________________________________________________________

MAILING ADDRESS_____________________________________________________________________________

CITY___________________________________________ STATE______________ ZIP ____________________

COUNTY _____________________________ HOME PHONE NUMBER _______________________________

CELL PHONE NUMBER _______________________WORK PHONE NUMBER ____________________________

E-MAIL ADDRESS ______________________________________________________________________________

ARE YOU A GM EMPLOYEE OR HAVE A RELATIVE THAT WORKS FOR GM __________________________

IF SO WORK LOCATION_________________________________________________________________________

$20.00 (YEARLY DUES) $10.00 ( EACH FAMILY MEMBER )

(YEARLY DUES ARE: JANUARY 1 -- DECEMBER 31)

PLEASE MAKE ALL CHECKS PAYABLE TO: GM AMATEUR RADIO CLUB or GMARC

NOTE: PLEASE ENCLOSE A PASSPORT PHOTO (For Your Membership ID)

MAIL TO:   GMARC
                   Bobby Corr - N8CY
                   45601 Fox Ln W Apt 106
                   Shelby Township, MI  48317-5054