Membership Form

Gloucester City Amateur Radio Club

NJ2GC

Membership Application Form

Name:

Call Sign:

Mailing Address:

Apt/Street

City, State, ZIP code:

e-mail address(es):

Home phone number:

Work phone number:

Cell phone number:

License Class:

If ARRL (circle)

Can your home station be operated without commercial power? Yes [ ] No [ ]

Signature_____________________________________ Date ______________

For office use only

Date submitted:

Date approved:

Gloucester City Amateur Radio Club NJ2GC