Last Name:       First Name:

Call Sign:    License Class: None Novice Technician General Advanced Extra

Street Address:

City:     State:   Zip:

Telephone - home:     Telephone - work:

Are you:

An ARRL Member?   Yes    No
An ARRL VE?    Yes    No
An ARRL Official or Appointee?    Yes    No

Do you have:

Mobile V/U/HF capability?    Yes    No
Hand Held V/UHF capability?    Yes    No
Emergency power capability?    Yes    No

Where do you like to operate?

If "other", please describe:

Favorite frequencies and modes:

Your birth MONTH: None January February March April May June July August September October November December     Your birth DAY: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
(You do not need to disclose your birth year).

The club uses email to notify members of upcoming meetings and other club events. Please list your email address here: Note that it will not be given out to any other organization.

The club has "vanity" email addresses available at no cost to you (ie, yourcall@ocarc-ny.org). This email address is forwarded to an existing email address of your choice. If you would like a "vanity" email address, please list the email address you would like your ocarc-ny.org account forwarded      to:

Annual Club Dues: $12.00

I agree to abide by the by-laws of the Orange County Amateur Radio Club, Inc. as amended. I understand that membership is granted by the Board of Directors and that it can be revoked by them at any time.  If you agree, please click the "I AGREE" button below to submit your application electronically.