N.F.L. Amateur Radio Club
Membership Application

*Name:
Call: Class: None Technician General Extra Other License Date: ie 01/25/2006
Gender:		Male Female
Address1: Address2: City: State: Zip: Phone: *Email Address:
Spouse's Name: Call: Class: None Novice Technician Tech + General Advanced Extra Other License Date: ie 01/25/2006
Hobbies other than Amateur Radio:
Would you like to serve on committees?		Yes Maybe No
Would you be interested in holding offices?		Yes Maybe No
Would you be interested in serving as a VE?		Yes Maybe No
Would you be interested in teaching others?		Yes Maybe No
Anything else you wish to add:
Visual verification: Type the letters shown in the picture
Signature:

Print the form after filling it out ( bring it to the meeting or mail to PO. Box 195 Corsicana, Tx. 75151-0652)
or
hit submit to email it to us.