** PRINT THIS FORM **

CPARC
MEMBERSHIP APPLICATION
CUMBERLAND PLATEAU AMATEUR RADIO CLUB
www.CPARC.net

NAME: ______________________________________________________
AMATEUR CALL: ___________________ LICENSE CLASS: __________

STREET ADDRESS:_____________________________________________
CITY: _______________________STATE: ___ ZIP: ____________

TELEPHONE: _______________________ EMAIL: ___________________

CLUB ACTIVITIES INTEREST: FIELD DAY ___ REPEATER NETS ___ HF NETS ___ HAMFEST ___

Dues are $24.00/year. Send this application and a check for $24.00 to the Cumberland Plateau Amateur Radio Club, P.O. Box 2956, Crossville, TN 38557. WELCOME ABOARD!