PLEASE complete a membership form for all new/renewal members.
Name: ______________________________________ Date: __________________
Call sign: ________________ Class [ Ex Adv Gen Tech Nov]: ___________
Street Address: ______________________________________________________
City, State, Zip: ____________________________________________________
Home phone: _____________________ Work phone: _______________________
ARRL Member? ____________________ Email: ____________________________
Preferred modes: (e.g. HF-SSB/VHF/QRP/Other): ________________________
Be an Elmer for new hams with: _______________________________________
Special topics of interest / suggestions for FARS meeting speakers:
Badge $12 [Clip / Pin / Magnetic] (circle choice)
Badge Name: __________________________ Badge Amount: ________________
Youth Rate ( ) Dues: ________________
Donation (optional): ________________
Send your check payable to FARS to this exact address:
PO Box 112551
Campbell, CA 95011
Membership runs for one year from January 1st through December 31st.
New membership applications accepted later in the year may have
their dues prorated (see dues schedule).
A Badge for a new member, or a replacement badge, is $12.
Your call sign and "badge name" (eg "Dick" for Richard)
as specified above above will appear on the badge.
We will use your first name if no "badge name" is specified.
Badge orders are not shipped, so they must be picked up
at a membership meeting.
* A youth membership rate is available for
new/renewing members who are under 18 years of age.
Check the "Youth Rate" above and enter $10 for the dues.
There is no proration on the Youth Rate.
Use this form to become a member of FARS,
or to renew membership.
Renewing members, or badge only orders, should provide at least
their name, call, and the date.
Also include any information that may have changed.
Put "N/A" where you wish to remove (or not provide) information.
Foothills Amateur Radio Society is recognized
as a 501(c)(3) non-profit under the Internal Revenue Code
and is also recognized by the California Franchise Tax Board.
This means that your Dues and any additional donation are
fully tax deductible on your Federal and California Tax returns.