BILL GREMILLION MEMORIAL RADIO CLUB, INC.
NEWNAN, GEORGIA

ANNUAL MEMBERSHIP APPLICATION

MEMBERSHIP YEAR: 2017-2018

Email address
Dues.....
Annual dues run from July 1 through June 30

Member dues are $30 with Family Membership available for an additional $5

A new member joining the Club after December 31 shall pay half (1/2) dues to carry him or her through the end of that membership year.

Dues may be mailed to:
BGMRC
Atten: Treasurer
P.O. Box 2327
Newnan, GA 30264

OR

PayPal (There is a $1 transaction fee added):
Go to: http://bgmrc.org/generalinfo.html#Membership for details

Application for:
Type:
Name:
Your answer
Amateur Call Sign
Your answer
License Class
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Home Phone
Your answer
Mobile Phone
Your answer
ARRL Member?
ARES Member?
Volunteer Examiner?
Family Members.......
Family members are those living in the same household of a full member.
Licensed family members have all club privileges.
1st Family Member - Name
Your answer
1st Family Member - Amateur Call Sign
Your answer
1st Family Member - License Class
1st Family Member - ARRL Member?
2nd Family Member - Name
Your answer
2nd Family Member - Amateur Call Sign
Your answer
2nd Family Member - License Class
2nd Family Member - ARRL Member?
3rd Family Member - Name
Your answer
3rd Family Member - Amateur Call Sign
Your answer
3rd Family Member - License Class
3rd Family Member - ARRL Member?
4th Family Member - Name
Your answer
4th Family Member - Amateur Call Sign
Your answer
4th Family Member - License Class
4th Family Member - ARRL Member?
Agree to terms and submit application.........
BY SUBMITTING THIS APPLICATION I STATE THAT ALL INFORMATION IS TRUE AND CORRECT. I HAVE READ AND AGREE TO ABIDE BY THE RULES OF THE CLUB’S CONSTITUTION AND BY-LAWS. I ALSO AGREE TO CONDUCT MYSELF IN RESPECT TO OTHERS AND OPERATE MY STATION IN ACCORDANCE TO GOOD AMATEUR PRACTICE.
Select "Read and accepted" or Exit the form
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms