Peekskill / Cortlandt Amateur Radio Association Membership Application
Date: ___________________ [ ] New [ ] Renewal
PERSONAL INFORMATION
Name: ____________________________________ Callsign: _________________________________ Address: ___________________________________________________________________________ City: _____________________________________ State: _________ Zip: _______ Phone Number(s): ____________________________________ Email Address: _________________ ARRL Member (Yes /No): ____________________ Publish Personal Information on Roster? [ ] Yes [ ] No (Please Check one)
MEMBERSHIP INFORMATION
[ ] Full Membership ($25.00/year) [ ] Associate Membership ($15.00/year) [ ] Student Membership (Free) [ ] Senior Membership (65 years and older - $10.00/year) [ ] Family Membership ($30.00/year)
I agree to abide by the Constitution and By-Laws of the Peekskill / Cortlandt Amateur Radio Association, Inc. Signature: _________________________________________ Date: ______________________________
APPLICANT - PLEASE DO NOT WRITE BELOW THIS POINT
Application Received by: ____________________________ Date: ______________________________
PCARA PO Box 146 Crompond, NY 10517 www.pcara.org email: mail@pcara.org
PCARA Inc. is a Volunteer Non-Profit Community Service Organization An ARRL Affiliated Club Member of UNYREPCO Member of the Cortlandt Regional Task Force for Emergency Planning and Citizen Corps Council