Allen County Amateur Radio Technical Society


2016 Membership Application

Name: _____________________________________    Callsign: ___________________

Address: ________________________________________________________________

City: _____________________________________ State: _____ Zip:_________-______

Phone number: (________) _______________________   unlisted?       Yes   (circle)

Email address: ___________________________________________________________

    Can we list your name & email address on the club web site?      Yes      No     (circle)

Membership Dues enclosed (please check one):

___ Full ($12)      ___ Additional family ($6)      ___ Associate ($6)      ___ Student ($6)

Are you an ARRL member?      Yes   (circle)

From the ACARTS WebPage


Please mail to: A.C.A.R.T.S.,   PO Box 10342, Fort Wayne, IN 46851

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