MARS W4BFB Member Profile Information Update Form

Have you upgraded your license, changed calls, moved, changed email address, etc. If you have made any changes, help us keep our membership records correct by completing this online form and then clicking the Submit button at the end of the form when you have finished.

Red Fields must be completed to Submit Form on line.

Name:   Last:    First:    Middle Initial:
Street Address:  
City:    State: North Carolina South Carolina -------------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other    Zip Code:
Home Phone:    Cell Phone:    Work Phone:
E-mail Address: Is this a change: No Yes
Personal Webpage:
Occupation:     Company:
Callsign:        (Type 'none' if unlicensed)
Old Callsign:  (If you have changed your Callsign)
License Class: Novice Technician Tech Plus General Advanced Extra not licensed     Expiration Date: (mm/dd/yyyy)
Do you have a club room key? No    Yes       If yes, Number
Newsletter Delivery Choice: Email    US Mail
ARRL Member? No    Yes
Other local radio clubs, organizations, affiliations: ARES   W4CQ   CDXA   UCARS  

Other hobbies, interests, comments, suggestions or additional information:

   

This page last revised: 09/02/2009 07:42:06 PM