LOS ANGELES AREA COUNCIL OF AMATEUR RADIO CLUBS

Treasurer:
URAC-BEVERYL PITMAN, WA6TIU
2902 ONRADO ST.
TORRANCE, CA 90503

Annual Dues $10.00

PLEASE FILL IN THE INFORMATION BELOW
AND SEND TO THE TREASURER

Club Name:     _______________________________________________________________

Club Mailing Address:     _______________________________________________________

Club E-mail Address:     ________________________________________________________

Club Web Page, if any:     _______________________________________________________

Meeting Place Address:     ______________________________________________________

Day(s) of month and time of meeting:______________________________________________

__________________________________________________________________________

Licensing Classes are held at (address):     ___________________________________________

___________________________________________________________________________
Day of week and time of Licensing classes:      ________________________________________

Phone number of Licensing classes:     ______________________________________________
ARRL Affiliated Club:    Yes:  _____  No: ____     ARRL Service Club:   Yes: ____  No: ____
Does your club have Liability Insurance?    Yes: ____  No: ____

If yes, with what company?     _____________________________________________________

Club President: Name and Call:     __________________________________________________

Address and Phone Number:     ____________________________________________________

____________________________  E-mail address:   __________________________________

Club Delegates to LAACARC:
1: Name and Call: _____________________________________________________________
Address and Phone Number:_____________________________________________________
___________________________________________E-mail Address:_____________________________

2:  Name and Call:   _____________________________________________________________________
Address and Phone Number:_____________________________________________________
______________________________________Email Address:__________________________

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