SCHUYLKILL   AMATEUR   REPEATER   ASSOCIATION,   INC.
P.O.  BOX  901,  POTTSVILLE,  PA   17901-0901

WWW.W3SC.ORG     
145.370         147.345         146.955         444.950

MEMBERSHIP APPLICATION:

Call ____________________

Name_____________________________________________________________

Address___________________________________________________________

City ______________________________________ State _______ Zip_________

County________________________ Phone Number ( _____ ) _______ - _______

License Class ________________________ Year Orig. Licensed ______________

I am a member of: ARRL ____ ARES ____ RACES ____ MARS ____ CAP ____

Email Address ________________________________

Do you want your address posted on website: Yes___ No___

I enclose my dues at the rate of $1.25 per mo. from now through Dec. of the current year.

Signature ____________________________________ Date_________________

Membership Type:      Single ($15/yr) _____             Family ($25/yr) _____

If family membership is desired please list family members on a separate application.

Make check payable to:   S.A.R.A.

Mail to:   S.A.R.A.,   P.O. Box 901,   Pottsville,   PA   17901-0901

Recommended by: ___________________________________________________

Date presented: ________________________

Approved: _____   Disapproved: _____   Reason: ___________________

Dues:   Amt. due: ___________   Rcvd. by: ____________   Date: ______________

Application form 04/05/09