Brantford Amateur Radio Club

Membership Application

Name Call sign Address     Address     City Province Postal code Phone E-mail Other call signs currently or previously held Amateur radio qualifications: Basic Basic(+) Advanced Code Year licenced Birthday Club affiliations RAC Membership No. ARRL QCWA AWA AMSAT NAQCC G-QRP FISTS RSGB   Other amateur clubs or organizations Main amateur radio interests Other interests Signature Date Club Use