Membership in the CVFMA

Connecticut Valley FM Association
Application for Membership or Renewal for 2008-2009

Callsign:______________  Name:______________________________________________

Phone:_______________  E-Mail:______________________________________________

Mailing Address:____________________________________________________________

City/Town:____________________________ State:_________________ ZIP:__________

ARRL League member(s)?____ Regular ______Life

 

Membership through July 30
Number	Kind of Membership	Cost	Amount
	LIFE  MEMBERSHIP (One Member no expiration)	$300	$
	FULL MEMBERSHIP (One Member 2008)	$20	$
	FULL MEMBERSHIP (Senior age 65 or older 2008)	$13.33	$
	FULL TIME STUDENT (Under 18 years and living at home 2008)	$10	$
	Additional Family Members (2008)	$6.67	$

 

Please accept my contribution to Repeater Maintenance----------------------------------$_______

TOTAL-$______      

Member Information

Your Birth Date:________________ Anniversary Date:__________________

Favorite Amateur Radio Interests: _______________________________________________

Spouse’s Name:___________________________ Spouse’s Birth Date:__________________

 

The Board wants to hear from you. Please add any comments, suggestions,
or concerns at the bottom or on  the reverse side of this application.

 

Send Completed Application and Payment To

Connecticut Valley FM Association

Bruce Van Houten, Treasurer

P.O. Box 35

Windsor, VT 05089

Updated September 23, 2008