Please Print this application and bring it with you to our next meeting or mail it to:

• Baycare Emergency Amateur Radio Service -BEARS (W4TCH)

• Attn: Dirk Palmer

• 3001 West MLK Blvd.

• Tampa, Florida 33607

Membership Application

Name: _________________________________     Date: _______________

Call Sign: ______________________ License Class: __________________

Address: _________________________________________

Address2: ________________________________________

City: __________________________   State: _______________  Zip: _____________________

Home Phone: ___________________ Work Phone: ____________________

E-Mail _________________________________________________________

Member of ARRL?  Yes ___No ___

Member of ARES/RACES?  Yes___ No ___

Do you have any NIMS , ARRL Emergency Training? Yes ____ No _____

What modes/bands are you interested in? ____________________________

Check what Bands you have equipment to operate:

160m____ 80m____ 40m____ 20m____ 15m____ 10m____ 6m____ 2m____ 70cm_____ higher____

Are you willing to participate in work parties for maintenance and upkeep of the club? Yes ___No___

Other comments: ______________________________________________________

_____________________________________________________________________

_____________________________________________________________________

The Baycare Emergency Amateur Radio Service (W4TCH) is open to all that are interested in Amateur Radio. We are looking for good, active, responsible members. You will be expected to abide by the constitution and by laws of the club, and uphold the Amateur Radio Operator's Code. You are encouraged to attend our business meetings held on the third Tuesday of the month at 6:30 p.m. Your application will be approved by a vote for membership from the board of directors and officers of the club.

Membership dues are $20 per year. Family membership can be extended to all members of your immediate family for $10 more.

Dues are pro-rated for the year.

I agree to the above (by your signature): _____________________________  Date: _____________________________

Sponsor Signature (Enter the name of a club member sponsoring you. That member will be contacted to qualify this application): _____________________________

FOR MEMBERSHIP COMMITTEE USE ONLY

Sponsor Approved: Yes ___No ____ Volunteer Badge #_______________________

1st Meeting _________ 2nd Meeting ________ 3rd Meeting ___________

Date of Membership Vote:____________ Approved: Yes___ No___

Membership Committee Approval: ________________________ Date: ___________