Club Membership Application

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Please complete the Membership Application below
to join the Mad Scientists Amateur Radio Club.

If you would prefer, you can download a .pdf file that you can print out and mail or fax back to us. (coming soon)

We will not share your information with anyone!

Items in Red are required - All others are optional.

Call Sign

On-Air Friendly/Handle

usually your first name or nickname

Full Name
Email
Alt. Email
 
Street Address

Suite or Apt. #

if applicable

City
State
Zip
 
Phone
Alt. Phone
Cell Phone/Pager
FAX
 

Amateur License Class
Novice
Technician
Technician-Plus
General
Advanced
Extra
 

Would You Like To Receive Club Email From MSARC?

club-related email only

Yes
No
   

What Donation Amount Are You Planning On Making (or have you already made) to MSARC?

any amount is appreciated

$35 for an Associate Club Membership
$90 for an Enhanced Club Membership
   


Any Additional Notes

any special interests?

please list the Name and Call of any immediate family members that might also use the MSARC repeaters?

don't be shy, we won't bite (too hard)

;)

or

- please click only one time and wait for a response -

If you have repeated problems with this form,
please email us at MemberSupport@MSARC.comREMOVE_THIS_FIRST.


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