Nittany Amateur Radio Club Membership form

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Version 11062023

Name, Callsign, Date of Birth and license expiry

First Name: *

Last Name: *

What is your callsign?

Your license Expiry date:

YYYY

Your date of Birth - We use this for performing a due diligence for suitability for membership. This data is not stored

YYYY

ARRL and VEC information, plus your license level

Are you an ARRL Member?

Yes

Clear selection

Are you an ARRL VEC?

Yes

Clear selection

Are you a W5YI VEC?

Yes

Clear selection

What is your license level?

Let us know your home address for any mailings that may go out to club members

Home address 1

Home address 2

Home address 3

Home City

Home State

Home Zip Code

Pennsylvania County

If you have an alternative address for mailings, click yes on the buttons below and fill out this section. If not, simply click on the "No" button, and move to the next section.

Use an alternative address for mailings?

Yes

Clear selection

Alternative address 1

Alternative address 2

Alternative address 3

Alternative address 4

Alternative City

Alternative State

Alternative Zip code

Telephone information

Primary Telephone

Secondary Telephone

Use your primary telephone in directory?

Yes

Clear selection

Use your secondary telephone in directory?

Yes

Clear selection

Email - NARC uses a listserver for club communications, as well as a way to disseminate the NARC Newsette Monthly club newsletter. Use the email address you with to use for this.

What is your email address?

Use your email address in the directory?

Yes

Clear selection

Membership level Full- if you reside in Centre County, PA and hold a current Amateur license, you can only be a full member. Licensed hams residing outside Centre County, PA can opt for Full Membership if they wish. Associate Membership - Anyone who does not have an Amateur License or lives outside Centre County PA. Family - Applicable to additional family members, residing in the same household, which have one member paying for Full or Associate membership.

Full Membership

Full

Associate Membership

Associate

Family Membership

Family

Clear selection

Callsign family member 1

Callsign family member 2

Callsign family member 3

Callsign family member 4

Thank you for your interest in the Nittany Amateur Radio club and filling in the form. Check on the submit button below.

Submit

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