Santa Clara Valley Repeater Society  MEMBERSHIP APPLICATION:

CALL:____________________________(PLEASE ATTACH A COPY OF YOUR LICENSE)

NAME:__________________________________________________ ___________________

HOME ADDRESS:_______________________________________________ ______________

CITY:__________________________________STATE:______ZIP: __________-________

HOME TEL (_______)________________________List in Roster ____Yes____No

ALT TEL  (_______)________________________List in Roster ____Yes____No

PACKET HOME BBS:___________________________________________________ _______

E-mail Address:_______________________________________________ ____________
Are You an ARRL Member?________________    (YES/NO/LIFE MEMBER)
REFERRED TO CLUB BY: NAME:________________________call:__________________

User Password _ _ _ _ _ _ _ _(numaric 4-8) Mailback callback Phone___ ____


MEMBERSHIP TYPE_____________________________            $________.______
(Regular, Family, Senior, New or Renewal and with or without PATCH codes)

NEW MEMBERSHIP FEE ($5.00)                              $________.______

DONATIONS (Member or Non-Member)             (Optional) $________.______

ARRL MEMBERSHIP ($34.00)                                $________.______
(13-21yrs- with one-time proof of age- $16.00)
 _______New ________Renewal
                                        TOTAL ->        $________.______

Donations are welcomed from both member and non-members and will be applied toward repeater site maintenance, antennas, cables, and other radio equipment projects! Thanks in advance.

              P.O. Box 20541
              San Jose, CA 95160-0541

Please be sure to select a user password to gain access to the user area of the web site and to be used with repeater control functions such as phone patches.  You can change your password on the web site.  The Mailbox callback number is needed so if you are paged by a system user, it has some place to go.  It also provides a nice auto dial to call home!!  A user number will be assigned by the club treasur or a control operator (a number between 120 and 199 that is not already taken).  Indicate in the margins if you have first, second or third choices.  e-mail is the preferred method of distributing information, we won't spam you, (hey, nobody knows how here)!!

Last updated 07/22/2002 ggm