INDIANAPOLIS RADIO CLUBMEMBERSHIP Form....

Please return this application request to any club officer at any meeting or mail to:
 
IRC Treas. Jay Willever-K9LJW; 12701 Whisper way, Fishers, IN , 46038 


Make checks Payable to :  Indianapolis Radio Club….

-------------------------------------------------------------------------------------------------------------------------

Name: ______________________________ Call: ___________ License Class ___________

Address: ______________________________________________________________City: ___________________________  State: ________ Zip: ____________________

Email Add. : __________________________________ Phone: _____ - ______________ARRL Member:  Yes   No   (circle one )

Official use :  [] Dues paid ____________ [] Card Issued  [] I  [] F  [] L

Tracking [] Sect.   [] Treas.   [] News editor   [] Pres.   [] ITC front Desk									

Form date: 12 dec 2005
modified:  5 Oct 2008