Looking to Join Us, or to Renew Your Membership?

Portland Amateur Radio Club
4110 S.E. Hawthorne Blvd., PMB 211   •   Portland, OR 97214
New Membership, Renewal and QSL Card Order Form

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 Member (to expire 12/31/03):  []  $18.00, Full or Associate  []  $12.00, Student