Membership Application Membership Application Name * Name First First Last Last Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Address Phone * Email * Password * eye_icon eye_slash_icon cancel1 check1 Eight characters minimum cancel1 check1 One lowercase letter cancel1 check1 One uppercase letter cancel1 check1 One number cancel1 check1 One special character What is the best way to contact you? * Please select an optionPhoneTextEmailWeekly NetSnail mail Birthday * Callsign * License Class * Technician General Extra Are you a member of the ARRL? * Please select an optionYesNo What aspects of amateur radio interest you? * By joining, what do you think the club can do for you? * Profile Picture Drop a file here or click to upload Choose File Maximum file size: 5MB Payment Annual Membership Fee * Club Membership Fee: $20.00 Payment Method * Please select an optionOnline - Credit CardOffline - Mail-In Check Number Payment I authorize State Line Radio Club to charge my card for the amount listed below * Agree Total to be charged I agree to adhere to the rules of Amateur Radio, both legal, in spirit, and intent. I also agree to abide by the rules and by-laws set forth by the State Line Radio Club. * signature keyboard Clear We Encourage our membership to join the American Radio Relay Legue (ARRL). Contact any club officer for more information. If you are human, leave this field blank. Submit
