Name: ______________________________________
Address: _____________________________________
City: _______________ State: ______ Zip: ____________
Phone (Home):__________ E-Mail Address:_______________
Call Sign:____________ Class of License:___________________
Membership Status: Regular ____ Associate ____ Family ____
Dues Submitted: $__________ (See: Membership)
Date of Application: ________________________
ARRL Member? Yes ____ No ____
American Red Cross Volunteer? Yes ____ No ____
Occupation:__________________________________________
Sponsoring Member (if any):__________________________
Other Hobbies or Interests:__________________________
Emergency Back-Up Power? Yes ____ No ____
Types of Equipment?(Check all that apply) HF ____ VHF ____ UHF ____ Other ____
Comments:________________________________________________
Send your completed application & dues to:
WCAARC • P.O. Box 441 • Jasper, Alabama 35502