Rains Amateur Radio Association
(Rains ARA)
Membership Application
Date: _________
Name: ______________________________ Callsign: ________________
Address: _____________________________________________________
City: ________________________ State: _____ Zip Code: ______-_____
Email Address: __________________________
Home Phone: (____) ____-______ Cell Phone: (____) ____-______
ARRL Affiliation: VE: Qualified ( ) yes ( ) no
Member: ( ) Yes ( ) No If Yes, with whom ______________
License Class:
( ) Unlicensed ( ) Novice ( ) Tech ( ) Tech+ ( ) General ( ) Advanced ( ) Extra
Name: ______________________________ Callsign: ________________
Address: _____________________________________________________
City: ________________________ State: _____ Zip Code: ______-_____
Email Address: __________________________
Home Phone: (____) ____-______ Cell Phone: (____) ____-______
ARRL Affiliation: VE: Qualified ( ) yes ( ) no
Member: ( ) Yes ( ) No If Yes, with whom ______________
License Class:
( ) Unlicensed ( ) Novice ( ) Tech ( ) Tech+ ( ) General ( ) Advanced ( ) Extra
Check where appropriate:
( ) Full Membership $20.00
( ) Associate Membership (Non Ham) $10.00
( ) Family Membership $ 5.00
Club Donation $______
Repeater Donation $______
Total Amount Enclosed $______
Make Check payable to: Rains ARA
215 Main St.
Sulphur Springs, TX 75482