Membership Application     
                      Arkansas River Valley Amateur Radio Foundation, Inc.
                                                    P.O. Box 582
                                      Russellville, Arkansas  72811

Name_________________________Call________ Class______ARRL Member____
Name_________________________Call________Class______ARRL Member____
Name_________________________Call________Class______ARRL Member____
Name_________________________Call________Class______ARRL Member____
Address__________________________________________________________
City___________________________________State________________Zip____
Home Telephone Number_________________E-mail address__________________

APPLICATION TYPE   (   ) NEW  (   ) RENEWAL (   ) CORRECTION


MEMBERSHIP TYPE
(  ) Individual  membership, 1 year...................$ 18.00*---*$1.50 x
the no. of mon. left in year
(  )Family membership, 1 year.............................20.00*---*$1.75 x
the no. of mon. left in year
(  )Associate membership, 1 year..........................9.00*---*$   .75
x the no. of mon. left in year
(  )Over 65/Under 16 membership, 1 year.............9.00*---*$   .75 x the
no. of mon. left in year
* Memberships are prorated for new members.  New members are those who have
not been
   members of ARVARF for two years.
(  )Check here if you do not want your information published in the club roster

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