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:_______________________________________________ ____________
User Password _ _ _ _ _ _ _ _(numaric 4-8) Mailback callback Phone___ ____
MEMBERSHIP FEES: MEMBERSHIP TYPE_____________________________ $________.______ NEW MEMBERSHIP FEE ($5.00) $________.______
DONATIONS (Member or Non-Member) (Optional) $________.______ ARRL MEMBERSHIP ($34.00) $________.______
Are You an ARRL Member?________________ (YES/NO/LIFE MEMBER)
REFERRED TO CLUB BY: NAME:________________________call:__________________
(Regular, Family, Senior, New or Renewal and with or without PATCH codes)
(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.
PLEASE MAKE CHECKS PAYABLE TO: SCVRS
SEND TO: SCVRS
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