Membership

S.C.A.R.A. Amateur Radio Club Member Information


Today's Date: (MM/DD/YY)



Call Sign: 



Type of License : 
First Name: Middle Initial: Last Name: Phone Number: Fax Number: Email Address: Mailing Address: City: State: Zip: Horizontal Bar

Station Equipment and Information

Base Station: Moblie Station: Hand Helds: Other Radio Clubs:
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Work Information

Occupation: Work Name: Work Address: Work Phone Number: Work Fax Number: City: State: Zip: Horizontal Bar

Other Amateurs In Immediate Family and Household:

Call Sign: Type of License :
First Name: Middle Initial: Last Name: Email Address: Relationship :
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Check Your Area(s) of Interest:
UHF
VHF
HF (Low Bands)
Emergency Service

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