SECARS Membership Application

First Name *

Last Name *

Call Sign *Enter "None" for Associate Member

License Class *

NoneTechnicianGeneralAdvancedExtra

Street Address *

Apartment, suite, etc

City

State

ZIP Code

Email Address *

Phone

ARRL Member *YesNo

ARES Member *YesNo

Membership Type *NewRenewal

Membership Level *IndividualFamilyYouthSelect Individual for over 18, Youth for under 18 or Family for multiple members in household

Date of Birth *

Number of Additional Family Members Over 18 yrs of Age *Additional family members over 18 are $5 per year. Do not include the primary applicant.

Number of Family Members Under 18 Years of Age *Family members under 18 are free.

Family Members - List Name and Call

Special Interests in Amateur Radio

Add a donation

USD

OPTIONAL - Add a donation to your membership dues

I prefer my donation to be anonymousYesNo

Amount Due

CommentsPlease enter any comments that you wish to include on your application.

Cover SECARS' PayPal fees for this orderYesNo

Submit

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2021-08-23