UARC Membership Application

Utah Amateur Radio Club
Membership Application

Required items shown in boldface type

Application for:	New Membership Renewal

Individual Membership: Regular Member, 1 year ($20.00) Regular Member, 2 years ($40.00) Regular Member, 3 years ($60.00)		Individual membership plus family member: Individual plus additional Family Member at same address, 1 year ($32.00) Individual plus additional Family Member at same address, 2 years ($64.00) Individual plus additional Family Member at same address, 3 years ($96.00)

Select one of the membership options above. Contact the UARC Secretary if you require an option other than those listed above.

Last Name:		First Name:
Middle name or initial:		Preferred nickname (if different from first name):

Optional note to the Secretary:
(Let us know about any of the above items you would prefer not to be published.)