OREGON TUALATIN VALLEY

AMATEUR RADIO CLUB

 

PO Box 5471

Beaverton, OR 97006-0471

 

WWW.OTVARC.ORG

OTVARC@gmail.com

 

MEMBERSHIP 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 $20.00 for 2016 [ ] $25 for Family Membership (at same address)

[ ] New Member $20.00 for 2016.

[ ] Family Member - Add $5.00 per additional member at same address.

 

 

INCLUDE COMPLETED FORM FOR EACH FAMILY MEMBER

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

 

Questions? Everett Curry W6ABM or 503.522.7142.

Updated: October 19, 2015