Allen County Amateur Radio Technical Society
Membership Application
Name: _____________________________________ Callsign:
___________________
Address: ________________________________________________________________
City: _____________________________________ State: _____ Zip:_________-______
Phone number: (________) _______________________
unlisted? Yes
(circle)
Email address: ___________________________________________________________
Can we list your name & email address on the club web
site? Yes
No (circle)
Membership Dues enclosed (please check one):
___ Full ($12) ___ Additional family ($6)
___ Associate ($6) ___ Student ($6)
Are you an ARRL
member? Yes (circle)
From the ACARTS WebPage
Please mail to: A.C.A.R.T.S., PO Box 10342, Fort Wayne, IN 46851
Click Here for Fort Wayne Radio Club Application