SARA Membership Form

Socorro Amateur Radio Association
Membership Form

Date: _________________________

Give this completed form and payment to any SARA officer or mail to: SARA, 722 N. California St., Socorro, NM 87801. Check the appropriate boxes below.

o New Membership or o Renewal - o Individual - $15 or o Family - $20

Name _____________________________________________ Callsign ____________________

Address _______________________________________________________________________

City __________________________________ State __________ Zip _____________________

Home Phone ___________________________ Work Phone _____________________________

email address __________________________

If you are a student or staff member at New Mexico Tech, or work for AOC/NRAO, please list your campus address below (to be used only to distribute newsletters).

Campus Address (Dept./Division/CS Box no.) ___________________________________________

_____________________________________________________________________________

Would you like to have an autodial number? If so, to what (local exchange) phone number would you like to have this apply? __ __ __ - __ __ __ __ .

For family membership, list the names of additional family members.

Name _____________________________________________ Callsign ____________________

Work Phone _____________________________ email address __________________________

Name _____________________________________________ Callsign ____________________

Work Phone _____________________________ email address __________________________

Name _____________________________________________ Callsign ____________________

Work Phone _____________________________ email address __________________________

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^{please do not write below this line}

date entered ____________ autodial assignment ________

membership expires ______________ initial ________