North Shore Radio Association Membership Application

Please use a form for each membership

Date:  New   Renewal    Update Info
Callsign:  Class: Year first licensed:
Full Name:   Name on air:  
City:   State:   Zip:
Phone (Home): (Cell):  
E-Mail address:   ARRL Membership #:

  Email Address is required if you plan to use the "Submit" button.

Your capabilities (bands, modes etc.):
Other hobbies & interests:
Referred by (if any):
Type of membership requested:
Student (full-time) 
Associate (family member)
If Associate, Call sign of the Full member in your household:


Membership runs from September 1st to August 31st
Full = $20   Student = $5   Associate = $5  
All new members remember to add $5 initiation fee.
Amount Due: 

Due to a problem with the website and the fact that we are migrating to word press..
This form can't be electronically submitted at this time..
Please take a snapshot of it or print it to a PDF and email it to memberships at!

and mail the amount due to:
NSRA Memberships, PO BOX 3724, PEABODY MA 01961-3724
or pay online add $1.00 & use PayPal Link on
Thank You Page after you print this Form.