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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
[] $24.00 Full Family Membership
[] 1000 QSL Cards (see sample above): $60.00 []
New Membership in ARRL: $39.00 (club gets rebate)
Please provide the following additional information for your
QSL cards:
County: ________________________ Former Calls: ________________________________
Awards: ______________________
[] ARRL Diamond [] ARRL Life Member
Logo [] No information boxes (for use with labels)
[] Other artwork (you provide) |
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