OREGON TUALATIN VALLEY

AMATEUR RADIO CLUB

880 N.E. 25th Ave., Suite 2-160

Hillsboro, OR 97124-6258

WWW.OTVARC.ORG

OTVARC@gmail.com

MEMBERSHIP RENEWAL/APPLICATION

To insure that our records are accurate and up to date, please fill out completely.

Name _________________________________ Call ____________ Date __________

  License Class:    [ ] Not Yet    [ ] Technician   [ ] General   [ ] Advanced    [ ] Extra

Address _______________________________________ E-mail ________________

City ___________________ State _____ Zip _____________ Phone (____)________

Spouse’s Name ____________ Spouse’s Call ______  Spouse Member? [ ] Yes [ ] No   

Your Occupation ______________ Company __________ Work Phone (___)_________

OTVARC Life Member? [ ] Yes [ ] No            Your DOB ___/___/___

ARRL Member? [ ] Yes [ ] No                         ARRL Life member? [ ] Yes [ ] No

ARRL Appointment? ____________            ARES Member?  [ ] Yes [ ] No

VE Certified? [ ] Yes [ ] No   Which Organization [ ] ARRL [ ] W5YI [ ] Other _________

Please indicate interests that you wish to support.

[ ] Bunny Hunting   [ ] Camping   [ ] Contest   [ ] Education   [ ] Elections  [ ] Elmer  [ ] Emergency Service

[ ] Equipment loan  [ ] FIELD DAY   [ ] Membership  [ ] OSCILLATOR   [ ] Packet  

[ ] Project Night   [ ] Public Awareness  [ ] Public Service   [ ] Repeater  [ ] RFI  

[ ] SEA-PAC  [ ] Social   [ ] VE Testing   [ ] VHF/UHF

[ ] Renewal $20 for 2008     [ ] $25 for Family Membership (at same address)

[ ] New Member - $12 Dues for 2008 including $2 application fee.

[ ] New Member - $30 Dues through 2009 including $2 application fee.

[ ] ARRL MEMBERSHIP $39 Annually or $36 if 65+   [ ] Add Family Members  $8.00 Each   

INCLUDE COMPLETED FORM FOR EACH FAMILY MEMBER

RETURN COMPLETED FORM(S) AND YOUR CHECK TO CLUB BOX ABOVE,

OR GIVE TO MEMBERSHIP CHAIR AT THE NEXT MEETING.  

Questions? Everett Curry W6ABM or 503.640.1088.

Updated: June 1, 2008