--------------------------
3900 CLUB MEMBERSHIP APPLICATION
NAME _____________________________________ CALL ___________ AGE _____
ADDRESS: STREET ____________________________________________________
CITY __________________________________ STATE _________ ZIP ___________
LICENSE CLASS ________________________ EXPIRATION DATE ______________
YEARS LICENSED ______ CALLS HELD ____________________________________
ARRL MEMBER? YES ___NO ___ XYL'S NAME ______________________________
OTHER FAMILY LICENSEES ______________________________________________
EQUIPMENT
HF --------------------------------- VHF-UHF
TRANSCEIVERS _______________________ ________________________________
AMPLIFIERS _________________________ ________________________________
ANTENNAS ___________________________ ________________________________
READING INTERESTS
Please indicate preference by first, second, etc.
QST ___ CQ _____ 73 ____ WORLD RADIO ____5YI REPORT ____ WESTLINK ____
OPERATING INTERESTS
CW__ SSB__ RTTY/AMTOR__ SLOW/FAST SCAN TV__ PACKET___MARS ___
SATELLITE ___ TRAFFIC ___ CONTESTS ___ ARES/RACES ___ OTHER __________
OTHER AMATEUR RADIO CLUBS
________________________________________________________________________
ARRL/ELECTIVE/APPOINTED OFFICES HELD
________________________________________________________________________
AWARDS
WAS ___ WAC ___ WAZ ___ DXCC PHONE ___ CW ___ MIXED ___ RCC ___ A1 OP ___
LIFETIME MEMBERSHIP IN THE 3900 Club is $2.00. There are NO annual dues.
The 3900 Club is an affiliated ARRL Club and is incorporated as a non-profit organization in the State of Iowa. Following the filing of your application, you will be introduced and your application will be read immediately after the bulletin during the next Sunday on-the-air meeting on 3900 Khz.
Send application to:
The 3900 Club Inc. - WØFZO
Bob Solbeck - NØGIV, Secretary/Treasurer
1009 - 4th Ave. N.
Humboldt IA 50548
To print out the above form CLICK HERE
This form requires use of the Acrobat Reader
If you do not have the program downloaded onto your PC,
you may click on the Adobe Acrobat logo here.
It will take you to their free download site.
