Membership Application Form

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Our dues are $20.00 per year ($10.00 for additional family members and students).
Dues are for calendar year (Jan 1st to Dec 31st) and are due September 1st.
Dues must be paid by the December meeting in order to continue your membership and be included in the roster.

Please send all completed forms to membership Chairperson: Brian Davis, W9HLQ
17038 Oconto Ave.
Tinley Park, Illinois 60477

Please Print Plainly and Fill In All Spaces


Last name ____________________________ First name ________________________________

Address _______________________________________________________________________

City ____________________ State __________ Zip ____________________

Phone _(____)__________________________

Callsign _____________________ Class _________________ Are you an ARRL member _____

Date of Birth ________________ Year first licensed ___________________________________

E- mail Address _________________________________________________________

Occupation (include even if retired) _________________________________________________

Business Address _______________________________________________________________

Business phone _(____)_____________________

Other Hobbies __________________________________________________________________

Committees you would like to serve on: Positions you might consider:

____Publicity               ____Newspaper                   ____Club Officer
____Refreshment         ____Membership                 ____Board Member
____Programs              ____Audit                          ____ Class instructor
____Awards                 ____Special Events            ____Net Control
____Elections              ____Field Day                    ____ Write articles for Hamgab
____Raffles                 ____Hamfest                      ____Packet Sysop
____Banquet               ____RFI/TVI                       ____Web support

Bands you operate_________________ Modes ______________