MVARA.club Moreno Valley Amateur Radio
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Moreno Valley Amateur Radio Association (MVARA)
Membership Application
and Emergency Radio Equipment Survey
Please enter your personal information then Submit this form.
( One person per form )
Regular Membership - $25.00 per year
Member Personal Information
*
Indicates required field
Please Select
*
New Member Application
Existing Member Renewal
Please tell us if you are new or renewing your existing membership.
Membership Type
*
Regular Member - $25.00
$12.50 - New member joining after July 1st
Please select your membership type
Name
*
First
Last
Date of Birth
*
Call sign
*
Enter your call sign here
Class of License
*
Tech
General
Advanced
Extra
Email
*
Note to club:
*
Any thing you wish to tell us about you or your information
Home Phone Number
*
Enter your Home Number ** If you only have 1 phone, enter the same number for both Home and Cell to complete the form.
Cell Phone Number
*
Enter Cell phone ** If you only have 1 phone, enter the same number for both Home and Cell to complete the form.
Changes in Personal Information since last year?
*
yes
No
Have you changed your address or other info since last year that we need to know about?
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Additional Information about you and your Station
Are you a member of any of these Groups?
*
ARRL
ARES
RACES
MARS
ACS
Check all that apply
RACES: what is your unit?
*
Tell us your Unit
MARS: what is your Branch
*
Tell us your Service Branch
ACS: what is your Unit?
*
Tell us you Unit
Which of the following do you have the equipment to preform?
*
VHF /UHF
HF - 10 M only
Yaesu Fusion Digital
HF
Winlink
Meshnet
PACKET
APRS
ATW
CW
RTTY
PSK
EME
AMTOR
PACTOR
SATELLITE
NONE
Please check all that apply
Other:
*
Explain other equipment
Please let us know how to expect your dues payment.
Please select one on these payment methods
*
I will pay now using the Pay Now button below
I will mail the payment to the address shown below
Please tell us how you will pay your membership dues.
Thank you for your application. Please double check your responses, then CLICK the SUBMIT button.
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Mail Check to:
M.V.A.R.A.
c/o 8365 Maynard Lane,
Riverside, CA 92508. [rev 1/19]
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