PVRC ONLINE MEMBERSHIP APPLICATION FORM

POTOMAC VALLEY RADIO CLUB ONLINE MEMBERSHIP APPLICATION
We invite you to join us!  Membership is open to all who are interested in amateur
radio contesting who reside in the DC/Maryland/Virginia region (plus parts of NC, PA, WV, 
and DE within the 175 mile radius allowed by the contest sponsors).
 
Please fill out this form and hit the submit button.
73 and good contesting!
Date:

First Name:

Last Name:

Call:

License Class:

Home Address (no., street, apt. no.):

Home City:

Home State:

Home Zip (+4 if avail.):

Home Phone:

E-mail Address:

Year First Licensed:

Previous Callsigns:

How can we help you become a member? Need a contact, next meeting location, etc.?

Date:
First Name:
Last Name:
Call:
License Class:
Home Address (no., street, apt. no.):
Home City:
Home State:
Home Zip (+4 if avail.):
Home Phone:
E-mail Address:
Year First Licensed:
Previous Callsigns:
How can we help you become a member? Need a contact, next meeting location, etc.?