Elmendorf Amateur Radio Society
C/O HQ AK CAP
PO Box 6014 
JBER AK 99506-6079 

Application for Membership Membership: $20/Yr  (Dues waived for year 2021)

Date:__________ 

Name: _________________________ 

Call Sign: _ _____________

Class of License (N/T/G/A/E): __________________ 

Contact Info –   Phone (H): _________ (W): ________

E-  mail: __________________________________________ 

Mailing AddressAddress1:__________________________________________ 

Address 2:__________________________________________ City:_______________________________   

State: ____   Zip: _________ 

Are you a member of the ARRL?         Y       N 

Duty Status: AD        RET     DEP     Civ Service     N/A       

Briefly describe current operation capability: (Bands, modes, fixed, mobile, portable, emergency power, etc.)

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What do you expect from a military amateur radio club?_____________________________________________

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Are there any projects, committees, or other activities that you would like to see happen?________________

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AdditionalComments?__________________________________________________________________________