February, 2005

the sPARCgap

Page      6     

Text Box: Portland Amateur Radio Club New Membership and Renewal Form PARC, PO Box 33454, Portland, OR 97292-3454 Name:____________________________________________________ Call: ______________________ Address:________________________________________________________________________________ City: __________________________________________ State: ________ ZIP: _____________________ Home Phone:: ___________________________________ □ Check here, if you do not want this number published. Work or Business Phone: ______________________________ □ Check here, if you do want this number in the club roster. Class of License: _____________________ ARRL Member? □ Yes □ No Expires: ____________________________________ E-mail Address: _________________________________________ □ Check here, if you do not want this address published. Please make checks payable to Portland Amateur Radio Club □ Renewing Member: □ $18.00 Full or Associate □ $12.00 Student □ $24.00 Full Family Membership □ New Membership in ARRL: $39.00 (club receives $15 commission) □ Donation: □ Repeater Fund □ Tower Defense Fund □ ARRL Spectrum Defense □ Other. Amount: $______________