LARA MEMBERSHIP APPLICATION (PLEASE PRINT or
TYPE)
THIS IS
A: [ ] NEW
APPLICATION
OR [
] RENEWAL
NAME:
___________________________________________________________________
CALL:
___________________ ARRL
MEMBER? [ ] YES [
] NO
ADDRESS:
______________________________________________________________________________
CITY:
__________________________________________
ZIP: ___________________________
PHONE:
(___________)
_____________________________
Email
Address is requested to Send Monthly Newsletter (Address
are never published except by
permission)
E-MAIL
ADDRESS
___________________________________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
DUES
PRICES:
INDIVIDUAL
MEMBER:
$15.00/YR
[
] INDIVIDUAL MEMBERSHIP
FAMILY
MEMBERSHIP:
$15.00/YR + $5.00/YR PER ADDITIONAL FAMILY MEMBER
**A
Family Member is a relative living in the residence of the
Primary Individual
[
] FAMILY MEMBERSHIP**
Membership
Note: Only 1 paper copy of the newsletter will sent
to each family address if email is not an option.
Download or Print Member form as PDF click
here