Membership/Renewal

Application

Pasadena Radio Club

W6KA

New Membership
Renewal
Update PRC Records

Post Office Box 282 Altadena, CA 91003-0282

You may pay your dues either in person at a Club meeting or via the Post Office Box above. Regular membership dues for the
calendar year are $25. Students pay half price. Additional household membership (all at one address, one newsletter).are free.
First time members only - join May through August for 75%, September through December for 50% the usual dues.
st
st
Renewals are full price, are due January 1 , and are late April 1 .
ARRL/QST the Club benefits from first time sign-ups made through the Club.

Call Sign
(if you have one)

License
Class

Expires (mm/dd/yy)

ARRL Member
Yes:

No:

First Name:

MI:

Same Address as last year?

Last Name:

Yes

No

Address:
City:

State

E-mail Address:
Home Phone:

Zip

@
(

Cell Phone:

Work Phone:

Is it OK to publish the following in the Club Roster?

Address:

Email Address:

Did you upgrade this year?

Yes:

Home Phone:
No:

Cell Phone:

Work Phone:

Did you change your call sign?

Yes:

No:

The Club needs chairpersons and helpers for several services each year that make the Club work.
Would you be willing to serve, or assist with any of the following?
Refreshments
Bulletin
Public Events
Holiday Banquet
Raffle
Elmer
Upgrades
What do you want from your Club? What are your interests and would be willing to participate in them?

Petition For Licensed Amateurs In The Same Household To Become Members (No Extra Cost) Attach another form for additional same household members

Call Sign

License
Class

First Name:

Last Name:

E-mail Address:

Home Phone:

Cell Phone:

ARRL Member
Yes:

Work Phone:

No:

Is it OK to publish the following in the Club Roster?

Address:

Email Address:

Home Phone:

Cell Phone:

Work Phone:

Can you receive a PDF version of our Bulletin newsletter on the web?

Yes

No

Do you wish to receive the Bulletin electronically?

Yes

No

Would you like to receive a reminder when the Bulletin is ready on the web?

Yes

No

PLEASE DO NOT WRITE BELOW THIS LINE - FOR USE BY TREASURER:

Paid by check
Posted to Database

Cash

Amount
To Accounting

Date