The Wabash Valley Amateur Radio Association, Inc. W9UUU / K9IKQ

W.V.A.R.A.
Membership Application
P.O. Box 81
Terre Haute, IN 47808-0081

A 501(c)(3) Organization

Please complete this form, print it out and include your dues with it. You may return this application in person or mail it to the address above with your payment.
Name:*
 Call sign:*
 License Class:*
Mailing Address:*

 Year Licensed:
 Home Phone:
City, State ZIP:*
 Renewal date:
 Work Phone:
Email Address:*
 Date of Birth:
 Cell Phone:
Application Type:*
New/Renewal ($20)1
Family ($5)1
Life ($400)3
Update
Other Memberships
ARRL
ARES
MARS
RACES
QCWA
10-X
Any other ham radio-related organizations, now or in the past?
If you are applying for a family membership, please list the Primary Member of the Household below. A seperate form must be submitted for each family member.
Primary Member Name: Call Sign:
By default you will receive the Bandspread Newsletter by Electronic email notifications. Uncheck the box if you want a printed copy mailed to your address? A Printed copy will only be sent to the Primary Family Member if this is a Family Membership, email copies are unlimited.
Do you want to pay your ARRL Membership through the Club?2 Yes No
Payment Due:
Comments or notes to the club:
* I have reviewed my information and it is accurate.
Print item  
Notes:
  1. Payment made after August 31st applies to the membership for the following year
  2. Your ARRL membership may also be paid through the club, enclose the appropriate forms with the ammount due. ARRL also has a family membership program. See QST.
  3. WVARA Life Membership is available for 20 times the current Single Membership rate. Family memberships are paid annually.
  4. Print a copy of your information and deliver it to the club. If you are applying for New Membership, Renewal or Life Membership, when we receive your payment we will process it.
  5. * Required Field

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