Membership Application:     YUBA SUTTER AMATEUR RADIO CLUB
Type:    New______   Renewal______

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Member Information: (full voting rights and privileges)

Name:_______________________________________________________

Address:_____________________________________________________

City,  State,  Zip:_______________________________________________

E-Mail:__________________________________________

Telephone: (_____)____________________   ARRL Member? (Y/N)__________

Call Sign_________________ License Class________________

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Associate Family Member (Living in the same Household only) ARRL Member? (Y/N)______

Name:___________________________________ Call Sign:_____________ License Class:___________

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Dues:; $___________________ ($18.00 per year)

Associate Dues: $___________________ ($4.00 per year)

Total: $____________

E-Mail Address_________________

Prefer Electronic Copy of Newsletter? (Y/N)_______
Newsletter can be viewed at http://users.cwnet.com/ysarc/. By selecting this option you will receive an E-Mail each month telling you the new newsletter is online.

Signature:______________________________________________

Print this Form, Fill it out and Mail with your dues to:
Yuba Sutter Amateur Radio Club
c/o Clara Ansley, KC6JPP
1943 16th Street Olivehurst, CA 95961

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Last updated on March 27, 2006