** PRINT THIS FORM ** CUMBERLAND PLATEAU AMATEUR RADIO CLUB (CPARC) www.cparc.net NAME:___________________________________________________ DATE:_____________ CALL SIGN:_____________________ LICENSE CLASS:_____________________________ STREET ADDRESS:___________________________________________________________ CITY:______________________________ STATE:_________ ZIP:_____________________ TELEPHONE:______________________ E-MAIL:___________________________________ CLUB ACTIVITY INTERESTS: FIELD DAY_____ REPEATER NETS _____ HF NETS _____ HAMFEST _____ VE TESTING _____ TRAINING CLASSES _____ ARES ______________ QRP _____ CW _____ HOME BREW _____ CONTESTS _____ OTHER ______________ Dues are $24.00/year. Membership dues are due and payable yearly on January 1st. New members who join CPARC after March 31st, will pay a prorated amount of $2.00 per month for the remaining months of the year. Alternately, new members joining in October, November or December may choose to pay the full amount of the yearly dues for the following year. In this case, membership would begin upon payment of this yearly amount. Send this application and your check to: Cumberland Plateau Amateur Radio Club, P.O. Box 1473, Crossville TN 38557