SUMMERLAND AMATEUR RADIO CLUB
                  Application for Membership.  (14/7/99)
                                    ( memapp.txt )- 10pt. Fixed width

Applic. No. ...........   Date: ..........................

Full Name: ................................................................

Street Address:............................................................

Postal Address:............................................................

Phone:.................... Wk:...................Fax:......................

Occupation:................................................................

Do you hold an Amateur Licence (Y/N)...... Grade:..........................

Callsigns: Previous:...............................Present:................

Member of the WIA? (Y/N).....Number:...............WICEN: (Y/N)............

Overseas Amateur Association?..............................................

Internet (Y/N).....Email:............................

                    Page:..................................................

Declaration by Applicant:
"I hereby declare that the particulars set out herein are true in every
respect. I agree at all times to abide by the Constitution and By-Laws of
this Club."

Signature of Applicant:.............................Date:..................

Signature of Proposer:..............................Date:..................

Signature of Seconder:..............................Date:..................

Received by Secretary (sign):.......................Date:..................

Passed by Committee (sign):.........................Date:..................

                                    (Chairman)

Fees Paid: $............. Rec.No.:................ Date:..............

   Current Fees- Full and Associate: $20 p.a.,  Permanent: $210.