Membership Application
Please put your callsign on the check (made out to LIARS) and complete below:
Dues are $30 individual, $35 family
Name:__________________________________________Callsign:__________
Address:_________________________________________________________
City:____________________________________State:_______Zip:__________
Phone #:______________________________
Publish in Roster? Yes[
]
No[
]
e-mail address:_________________________
Publish in Roster? Yes[
]
No[
]
License:
[
]Novice
[
]Tech
[
]Tech+
[
]General
[
]Advanced
[
]Extra
ARRL Member: Yes[ ] No[ ]
[
]Check to receive the Roster by e-mail-Valid e-mail address required
********************************************************************************************
Second member info (living in same household)
Name:__________________________________________Callsign:__________
Phone #:______________________________
Publish in Roster? Yes[
]
No[
]
e-mail address:_________________________
Publish in Roster? Yes[
]
No[
]
License:
[
]Novice
[
]Tech
[
]Tech+
[
]General
[
]Advanced
[
]Extra
[
]Check to receive the Roster by e-mail-Valid e-mail address required
Amount Enclosed (there is room here to send in dues for two people)
Membership Dues expire December 31st of the current year
Total Enclosed:
$_______________
If paying for more than 2 in your home, Please use an additional sheet.
I respectfully request that this application be considered by
the Officers and Directors of LIARS.
Date:___________
Signature:______________________________________________
[
] Please check here if any info on this form has changed from last year
Dues expire December 31st of the current year