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Antietam Radio Association P.O. Box 52 Hagerstown Maryland 21741-0052

Membership Renewal/Application
Year _______

Full Name (include middle initial & suffix if any)___________________________________

Call (if any) ____________ License Class __________________ Expires _______________

Spouses Name ____________________________ Call (if any) _______________________

Address __________________________________________________________________

City ______________________ State _____ Zip Code (+4 if available) ________ - _______

Phones HOME ____________ WORK _________________ E-Mail _____________________

Club Membership ARRL ? __ Y __ N _ Others ___________________________________________

Are you involved in RACES? ____ ARES? ______ SKYWARN?____ Sign me up as indicated ___

I can operate in: H.F. Bands/Modes ___________________________________________________

VHF(30 MHz - 300 MHz) Bands/Mode ________________________________________________

UHF(300 MHZ - up ) Bands/Modes ___________________________________________________

FAVORITE BANDS & MODE of operation _____________________________________________

Activities you enjoy in amateur radio _______________________________________________

Can you operate on emergency power? ___________ What Bands/Modes?________________

Do you have a copy of the : Repeater Guide? _______ Club By-laws? _________

Type of Membership FULL / FAMILY MEMBER / STUDENT( Circle One, Please)