BARC Membership – Beargrease Amateur Radio Coalition


        
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Membership allows one vote per member (or one vote per person with family memberships) for all BARC activities and elections. Membership dues support club activity and remaining funds are donated to the owners of the repeater systems that BARC relies on. All information on this form will be kept confidential.
Call SIGN*
First Name:*
Last Name:*
Address*    
                    
                         
                                        
                                        Street Address
                                    
                                        
                                        Address Line 2
                                    
                                    
                                    City
                                 
                                        
                                        State
                                      
                                    
                                    ZIP Code
                                
                    
                
Cell Phone*
Home Phone
Email*
                            
                        
                    
                    
                          
                    
                
                
                    
                        Emergency Contact Information:
Emergency First Name:*
Emergency Last Name:*
Relationship:*
Emergency Cell Phone*
Emergency Home Phone
Emergency Email
                            
                        
                    
                    
                          
                    
                
                
                    
                        BARC Membership*
Spouse Call SIGN*
Spouse First Name:*
Spouse Last Name:*
Spouse Cell Phone*
Spouse Home Phone
Spouse Email
                            
                        
Optional Repeater Donation $
					
				
Optional BARC Donation $
					
				
Total
							$10.00
							
						
Credit Card*
					
						Cardholder Name
					
					
						Card Details