5301
Bolsa Ave., Huntington Beach, CA 92647
CLUB #1729
APPLICATION FOR MEMBERSHIP/RENEWAL
NAME:
_____________________________________________________________
CALLSIGN:___________ LICENSE
CLASS:_____________EXPIRES:___________
ARRL MEMBER YES_________NO__________ EXPIRES____________________
WORK ADDRESS:
LOCATION/DEPT:___________________
EMPLOYEE NO.:____________________
MAIL STATION:
____________________ PHONE EXTENSION: ________________
BEEPER PHONE
NO:___________________________PIN:___________________
Email Address:
_______________________________________________________
HOME ADDRESS:
STREET:___________________________________________________________
CITY:__________________________________ZIP
CODE:____________________
HOME PHONE
NO:(____)________________Do Not List Home Data on Roster(3)__
Email Address:
________________________________________________________
PERSONAL AMATEUR RADIO
EQUIPMENT: _______________________________
__________________________________________________________________
RADIO INTERESTS:
(circle) DX Contests VHF 6M, 2M, 220MHz, 440MHz
HF
160M, 80M, 40M, 20M, 15M, 10M CW Traffic Nets T-Hunts
UHF
1.2G, 2.4G ATV Phone RTTY Packet (BBS_______________)
EMERG.
COMM. SSTV Satellite Other______________
Make checks payable to: BEARS-HB
Boeing Employees Amateur Radio Society
- Huntington Beach
Return
Form to: Dan Minear, mailcode 841-SL94