Burlington Amateur Radio Club Membership Application Form
Please fill out this form completely and submit it.
What is your name? *
ie: Paul Hope
Your answer
What is your Amateur Radio Call Sign?
ie: W1KOO
Your answer
What is your license class?
Novice, Tech, General, Advanced, Extra
What is your current mail address? *
ie: 29 Mansfield Avenue Burlington, VT 05401
Your answer
What is your primary phone number? *
Your answer
What is your secondary phone number?
Your answer
What is your email address? *
Your answer
Are you a member of the ARRL? *
What is your primary area of interest in the hobby? *
Making new friends, emergency services, QSL Cards, Satellites, Contesting, electronics, etc.
Your answer
Which membership type are you applying for? *
Individual, Subscription, etc.
How will you be paying? *
Cash, Check, Credit Card
Submit
Never submit passwords through Google Forms.
This form was created inside of Burlington Amateur Radio Club. Report Abuse - Terms of Service