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OMIK MEMBERSHIP APPLICATION
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* Indicates required question
Call Sign (if no call sign, enter NONE)
*
Your answer
First Name
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Your answer
Last Name
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Your answer
License Class
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Novice
Advanced
Technician
General
Amateur Extra
None
Address
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Your answer
City, State, Zip
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Your answer
Phone Number
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Your answer
E-mail address
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Your answer
Sponsor's Name and Call Sign (if applicable)
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Your answer
Membership Level Applied For:
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Regular - $20 (receive all publications, vote and all member privileges)
Family - $25 (up to three members per household)
Senior (80+) - $10
Associate (not FCC licensed) - $15 (receives all publications, but no voting privileges).
Required
I am remitting my membership fee by
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Check - make payable to OMIK and mail to Courtney D. Smith, OMIK Secretary, 30 Hartz Drive, Bridgeton, NJ 08302
Online - Online payment instructions will be emailed to you.
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