Mad Scientists Amateur Radio Club - San Mateo - San Jose - Bay Area

Club Membership Application

| Donations | Roster | Survey |

Please complete the Membership Application below
to join the Mad Scientists Amateur Radio Club.

If you would prefer, you can download a .pdf file that you can print out and mail or fax back to us. (coming soon)

We will not share your information with anyone!

Items in Red are required - All others are optional.

Call Sign
On-Air Friendly/Handle usually your first name or nickname
Full Name
Email
Alt. Email

Street Address
Suite or Apt. # if applicable
City
State
Zip

Phone
Alt. Phone
Cell Phone/Pager
FAX

Amateur License Class	Novice Technician Technician-Plus General Advanced Extra

Would You Like To Receive Club Email From MSARC? club-related email only	Yes No

What Donation Amount Are You Planning On Making (or have you already made) to MSARC? any amount is appreciated	$35 for an Associate Club Membership $90 for an Enhanced Club Membership

Any Additional Notes any special interests? please list the Name and Call of any immediate family members that might also use the MSARC repeaters? don't be shy, we won't bite (too hard) ;)

- please click only one time and wait for a response -

If you have repeated problems with this form,
please email us at MemberSupport@MSARC.comREMOVE_THIS_FIRST.