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