MEMBERSHIP APPLICATION 

We invite you to join the Chicago Suburban Radio Association.  
You need not be an Amateur Radio Operator to become a club member - 
however we'd be happy to help you reach for a license if you wish!
 Fill out the following areas and print out this form.

           Callsign:     Class: (select)

Name:

Address:
City:   State:   Zip:
Home Phone:   Other Phone:
  E-mail:
Occupation: 
     First Licensed:   Month/Year

    License Expires:  Month/Day/Year

    ARRL Member:   Yes  No

 Modes you operate: HF  VHF/UHF  Digital/SSTV/RTTY/PSK
 
CSRA offers family memberships for your immediate family living

at your address for an additional $5 each.  You can list them here:

  Call           Name                                 Class (select)

   

   
  I am willing to help CSRA by assisting with:

  PR Committee  Membership Committee   Field Day Committee

  CSRA Newsletter Reporter/Photographer  Parades, Public events, etc.

  Teach Ham Theory  VE Testing  Election Committee

  Elmer to new hams  Technical advice/consultation

  Elected Office   Club meeting program coordinator

I wish to apply for membership in Chicago Suburban Radio Association and agree to abide by the rules and regulations.

Signature __________________________ Date: ________

 

 
  CSRA Annual Dues                               Code             Amount
  Individual Membership (Under 65)              REG             $15.00

  Additional Family Member                        FMR             $5.00

CSRA Annual Dues - Code _________    Amount $ _________

Additional Family Members $5 x _____    Amount $ _________

Total Paid to CSRA...............................     Amount $ _________

Send this completed form along with your 
check or money order, payable to:
Chicago Suburban Radio Association.


2319 Westwood Dr.
Hillside, Illinois 60162

back to home

No information will be sold or used for profit.
All contents are only for the use of the Chicago Suburban Radio Association.

Rev 10/24

     rev 05/2018

setstats 1