Online Application to Join - Kings County Radio Club

Todays Date

First Name

Last Name

Name you would like to be Called by, ( No Nicknames Please )

Your Birthday

Call Sign

Class License *

First Licensed in

Phone (Home)

Phone (Business)

Phone (Cell Phone)

Email Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Select How did you hear about Kings County Radio Club? *

If you selected Other: How did you hear about us?

The Repeater you are most often on

Enter What Bands and Mode you most operate on

Are you a member of A.R.E.S, R.A.C.E.S., M.A.R.S., S.A.T.E.R.N., SKYWARN or N.T.S.?YesNo

If so, which ones?

Would you like to learn more about any of the above public services? If so, which service(s)?YesNo

Are you presently a Volunteer Examiner (V.E.)?YesNo

If you hold a General License class or above would you like to learn about becoming a V.E.?YesNo

Would you be interested in assisting with the Club’s Technician Radio Classes (theory, government regulations, and/or demonstrations)?YesNo

Would you be interested in being an Elmer for a new Ham, or Club member?YesNo

Are you presently a member of the American Radio Relay League (ARRL)?YesNo

If not, would you be interested in learning more about the ARRL?YesNo

Which Membership Plan will you Join. *

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