Online Membership Application

Firstname *

MI *

Lastname *

License class *

Callsign

Address *

City *

State *

Zip + 4 *

Primary Phone *

Secondary Phone

Email address *

Birthday *

Nickname

Emergency Contact Name *

Emergency Phone Number *

File Upload Please provide your photo

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The Radio Club receives $15 for each NEW Club member subscribing to the ARRL.
Your payment MUST be made directly to the Radio Club of Tacoma , NOT to ARRL.
The Radio club of Tacoma also recieves funds from ARRL for renewals.

I am applying for....

Choose from the following

Licensed Full member under 65

Licensed Senior member over 65

Associate 1 *

Associate 2 *

Licensed full-time student *

Life membership

Licensed family member at home **

Licensed family member at home ***

Promotional

Notes:

* Associate 1 non-licensed inividual from Washington state without voting rights.
* Associate 2 any individual licensed or not, out of state or internation without voting rights.
* Full time student to age 25
** Family first two living in the same residence.
*** Family after first 2 living in the same residence.
* Promotional free through Dec31st of testing year

** Electronic Payment Fee $2.00

Total Selected Membership Fees *

When you submit this form you will be redirected to Paypal for an online payment.

MEMBERSHIP APPLICATION - RENEWAL FORM

I am applying for....

Choose from the following