Membership Application
Please fill out and mail to: Mt. Vaca Radio Club, Inc., P.O. Box 417405 , Sacramento CA 95841-7405
Name:_______________________________________
Address: ____________________________________
City, State: _____________________ Zip: ________
Phone Home: ___________________ listed y/n __
Work: ___________________
Email address: _______________________________
Web URL: ___________________________________
Call: __________
License Class: ____ (T,,G,A,E)
Ham years:____ ARRL member (yes/no) : ___
Skills and interests:
Radio (RF) _____
Mechanical _____
Computers _____
Other _________________________________________
Special Interest: ________________________________
______________________________________________
Signature: _______________________________
Application for full Membership is $48 ___ or Sponsor donation $15 ___.
Date: _______ Make check payable to: Mt. Vaca Radio Club, Inc.
Licensed Family Members in same household (Associate
Members)
1. Name: _____________________________________
Call: __________ Ham years: ____
License: ____ (T,G,A,E)
2. Name: _____________________________________
Call: __________ Ham years: ________
License: ____ (T,G,A,E)
3. Name: _____________________________________
Call: __________ Ham years: ____
License: ____ (T,G,A,E)
4. Name: _____________________________________
Call: __________ Ham years: ________
License: ____ (T,G,A,E)