MEMBERSHIP APPLICATION 

We invite you to join the Chicago Suburban Radio Association.  
You need not be an Amateur Radio Operator to become a club member - 
however we'd be happy to help you reach for a license if you wish!
Fill out the following areas and print out this form.

           Callsign:     Class: (select) 

Name:

Address:
City:   State:   Zip:
Home Phone:   Other Phone:
  E-mail:
Occupation:
     First Licensed:   Month/Year
    License Expires:  Month/Day/Year
    ARRL Member:   Yes  No
 Modes you operate: HF  VHF/UHF  Packet/SSTV/RTTY/EchoLink
CSRA offers family memberships for your immediate family living
at your address for an additional $5 each.  You can list them here:
  Call           Name                                 Class (select)
   
   
  I am willing to help CSRA by assisting with:
  PR Committee  Membership Committee   Field Day Committee
  CSRA Newsletter Reporter/Photographer  Parades, Public events, etc.
  Teach Ham Theory  VE Testing  Election Committee
  Elmer to new hams  Technical advice/consultation
  Elected Office   Club meeting program coordinator

I wish to apply for membership in Chicago Suburban Radio Association and agree to abide by the rules and regulations.

Signature __________________________ Date: ________

 

 
  CSRA Annual Dues                               Code             Amount
 
Individual Membership (Under 65)              REG             $10.00
  Senior Citizen (65 and over)                      SNR             $10.00
  Additional Family Member                        FMR             $5.00

CSRA Annual Dues - Code _________    Amount $ _________

Additional Family Members $5 x _____    Amount $ _________

Total Paid to CSRA...............................     Amount $ _________

Send this completed form along with your 
check or money order, payable to:

Chicago Suburban Radio Association
.


855 So. Kenilworth Avenue
Oak Park, Illinois 60304

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No information will be sold or used for profit.
All contents are only for the use of the Chicago Suburban Radio Association.

     rev 1/2011

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