Birmingham Amateur Radio Club 

** Membership Application ** 

____ New Application ____ Renewal ____ Information Update 

Call Sign (if licensed): _____________________ License Class: _______________________ 

Membership Class: 

____ Regular Membership (Licensed Amateur) Dues: $25.00 / year 
____ Senior Membership (Licensed Amateur AND 65 years of age) Dues: $15.00 / year 
____ Life Membership (Licensed Amateur AND 70 year of age AND BARC member for 
     Minimum of 5 consecutive years) Dues waived per by-laws 
____ Family Membership (Living in same household as a Regular, Senior or Life Member) 
     Dues: $10.00 / year. Call of ‘Regular’ BARC Member: __________________ 
____ Student Membership (Full time student through the 12th grade) Dues: $12.50 / year 
____ Associate Membership (Unlicensed Individual) Dues: $12.50 / year 

Name: ______________________________________________________________________
Address: ___________________________________________________________________
City: ____________________________________ State: ____________ Zip: ________
Phone: Home __________________ Work: ________________ Cell: ________________
Occupation: ______________________________ Employer: _______________________
E-Mail Address: ____________________________________________________________


(Newsletters will be distributed via email unless otherwise specifically requested.) 

Are you an ARRL (American Radio Relay League) Member? 	____ YES ____ NO 
Do you desire to be a member of Birmingham Amateur 
Radio Emergency Service (BARES) 						____ YES ____ NO 

I pledge that the above information is correct and that I will abide by the Club rules. 

Signed: ____________________________________________ Date: ___________________ 

Mail with check to: 

Birmingham Amateur Radio Club
ATTN: Membership Vice President
PO Box 603
Birmingham, Alabama 35201-0603