North Kitsap Amateur Radio Club
Online Membership Application/Renewal Form

New Membership Renewal (Please check one)  Date:

Name:               Call:

Class: E A G T+ T (Check One)               ARRL Member: Yes No

Street Address:

City: State: Zip:

Home Phone: ()

Email Address:

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Family Memberships for:

Name: Call:
Class E A G T+ T (select one)

Name: Call:
Class E A G T+ T (select one)

Please fill in the applicable lines below:

Regular Memebership(s) at $15.00 each:     

Senior Membership(s)* at $12.00 each:        

Student Membership(s)** at $6.00 each:           
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Fill in additional family members if applicable:

Additional Family Member(s) at $10.00 each:  
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Total Dues submitted:. . . . . . . . . . . . . . . . . . . . . . . . . .
(Make checks payable to "NKARC")

* Age 65 or older
** Must be enrolled in grades 1-12 or equivalent to use student membership
Dues are normally paid in December and cover the following January to December, inclusive.

Disclaimer: All applications are pending until dues are received.