OREGON TUALATIN VALLEY
AMATEUR RADIO CLUB
PO Box 5471
Beaverton, OR 97006-0471
To insure that our records are accurate and up to date, please fill out completely.
Name _________________________________ Call ____________ Date __________
License Class: [ ] Not Yet [ ] Technician [ ] General [ ] Advanced [ ] Extra
Address _______________________________________ E-mail ________________
City ___________________ State _____ Zip _____________ Phone (____)________
Spouse’s Name ____________ Spouse’s Call ______ Spouse Member? [ ] Yes [ ] No
Your Occupation ______________ Company __________ Work Phone (___)_________
OTVARC Life Member? [ ] Yes [ ] No Your DOB ___/___/___
ARRL Member? [ ] Yes [ ] No ARRL Life member? [ ] Yes [ ] No
ARRL Appointment? ____________ ARES Member? [ ] Yes [ ] No
VE Certified? [ ] Yes [ ] No Which Organization [ ] ARRL [ ] W5YI [ ] Other _________
Please indicate interests that you wish to support.
[ ] Bunny Hunting [ ] Camping [ ] Contest [ ] Education [ ] Elections [ ] Elmer [ ] Emergency Service
[ ] Equipment loan [ ] FIELD DAY [ ] Membership [ ] OSCILLATOR [ ] Packet
[ ] Project Night [ ] Public Awareness [ ] Public Service [ ] Repeater [ ] RFI
[ ] SEA-PAC [ ] Social [ ] VE Testing [ ] VHF/UHF
[ ] Renewal $20.00 for 2016 [ ] $25 for Family Membership (at same address)
[ ] New Member $20.00 for 2016.
[ ] Family Member - Add $5.00 per additional member at same address.
INCLUDE COMPLETED FORM FOR EACH FAMILY MEMBER
RETURN COMPLETED FORM(S) AND YOUR CHECK TO CLUB BOX ABOVE.
Updated: October 19, 2015