Burlington Amateur Radio Club Membership Application Form
Please fill out this form completely and submit it.
What is your name?
ie: Paul Hope
What is your Amateur Radio Call Sign?
What is your license class?
Novice, Tech, General, Advanced, Extra
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 is your primary area of interest in the hobby?
Making new friends, emergency services, QSL Cards, Satellites, Contesting, electronics, etc.
Which membership type are you applying for?
Individual, Subscription, etc.
Individual 1 Year - $20 - One time Payment
Individual Subscription - $20/yr - Paypal required
I pledge to make a donation of $15 or more for the Associate Membership
How will you be paying?
Cash, Check, Credit Card
NEW! Use a credit card (via PayPal, Paypal membership not required)
Never submit passwords through Google Forms.
This form was created inside of Burlington Amateur Radio Club.