Umpqua Valley Amateur Radio Club

Membership Application

Membership information:

An interest in amateur radio is the only requirement to join the Umpqua Valley Amateur Radio Club. Dues are $10.00 for individuals and $5.00 for each additional family member living at the same address per calendar year. Associate membership (no FCC license) dues are $5.00. Dues are prorated (NEW members only): Jan - Mar $10/5 (each additional member); Apr - Jun $7.50/3.75; Jul - Sep $5/2.50; Oct - Dec $2.50/1.25. Membership is free for licensed students, 18 and younger. Make checks payable to: UVARC.

Please complete the form below and press the Submit button to send your application to the Membership Chairman. Then, mail your dues payment, payable to UVARC, to PO Box 925, Roseburg, OR 97470. Your application will be pending until your dues payment is received by the Club Treasurer.

CHANGES to your information may be made using this form, but all spaces used on the original application must be completed.

(Note: Phone number should be formatted like 541-555-1212)


Primary Member
First Name Last Name Call Sign Class ARRL Member?

Spouse
First Name Last Name Call Sign Class ARRL Member?
Address
City State Zip
Phone E-Mail Newsletter Delivery