Burlington Amateur Radio Club Membership Application Form
Please fill out this form completely and submit it.
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What is your name?
 *
ie: Paul Hope
(For Family Subscription you can list multiple names, or fill out a form for each person but only pay once.)
What is your Amateur Radio Call Sign?
ie: W1KOO
What is your license class?
Novice, Tech, General, Advanced, Extra
Clear selection
What is your current mail address? *
ie: 29 Mansfield Avenue Burlington, VT 05401
What is your primary phone number? *
What is your secondary phone number?
What is your email address? *
Are you a member of the ARRL? *
What are your primary areas of interest in the hobby?  (Checks as many as you choose.) *
Required
Which membership type are you applying for? *
Required
How will you be paying? *
Cash, Check, Credit Card
Submit
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This form was created inside of Burlington Amateur Radio Club.