Membership

MEMBERSHIPS ARE ACCEPTED THROUGHOUT THE YEAR

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Loveland Repeater Association

Application for Membership

Thank you for your interest in the Loveland Repeater Association.

Please print, fill-out and send this form to the address on the bottom of this page.

[ ] I would like more information on Amateur Radio.

[ ] Add my name to your Amateur Radio Classes mailing list.

[ ] I want to join the LRA. My payment is enclosed.

[ ] I want to renew my LRA membership. My payment is enclosed.

=> Yearly Dues Begin January 1st

=> Family/Individual Membership: $25.00 (Pro-rated at $2.10 / Month)

=> Under 18 Membership: $5.00/Yr

NAME: _________________________________________________________________

CALLSIGN: _________________________________________

ADDRESS LINE 1: ___________________________________________

ADDRESS LINE 2: ___________________________________________

CITY:______________________________________________________

STATE: __________ ZIP: ___________________________________

LANDLINE: _________________ MOBILE: ______________________

LICENSE CLASS: ____________________________________________

EMAIL ADDRESS: ____________________________________________

PACKET ADDRESS: ___________________________________________

UNDER 18? [ ] No [ ] Yes

ARRL MEMBER? [ ] No [ ] Yes

ARES/SKYWARN MEMBER? [ ] No [ ] Yes

Loveland Repeater Association

PO Box 7775

Loveland, CO 80539-7775

http://www.LovelandRepeater.org

[JF20100309-1]

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