North Shore Radio Association Membership Application

Please use a form for each membership

Date:  New   Renewal    Update Info
Callsign:  Class: Year first licensed:
Name:   Name on air:   Birthday:
Address:
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:
Full 
Student (full-time) 
Associate (family member)
If Associate, Call sign of the Full member in your household:
Dues: 
Membership runs from September 1st to August 31st
Full = $20   Student = $5   Associate = $5  
All new members remember to add $5 initiation fee.
Particle year, Sept.- Nov.=Full price, Dec.-Feb.=$15, Mar.-May=$10, 
June-Aug=Full price credited to next year's membership.(3 months free)
Amount Due: 

Fill out form and Print or 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 Submit Form.

 
FORM-12707-KA1NCF