Please print this form and mail to the address below.

NAME ___________________________________________________________

CALLSIGN _____________________ CLASS (AE, G, T) _________

ADDRESS ________________________________________________________

APT # _________________

CITY___________________________________ STATE_______ ZIP_________

PHONE_______________________ EXT________

E-MAIL ADDRESS: ________________________________________________

ARRL Member? Yes / No        Birthday (Month/Day) ______ /______

Year First Licensed _____________

Member dues $5.00 per person.

MAIL TO BARS TREASURER: (Make check payable to BARS)
ANNA RAE SANDER, KD4CGW
2036 MARACAIBO ROAD,
JACKSONVILLE, FL. 32211-5091

DATE DUES PAID _______/_______/_______    Amount $______________