Atlanta Radio Club, Inc.
P. O. Box 720398
Atlanta, GA 30358
| New [__] | Renewal [__] | Treas. Use: | Date Paid:_____ | Amount:______ | Cash [__ ] or Check #_____ |
Address ________________________________________________City_______________ ST____ Zip__________
Phone (H)________________ Phone (O) _______________Phone (Fax)______________
E-Mail _________________Birthdate_____________ Spouse's Name_____________
Is your telephone an UNLISTED Number? (Y/N) ______
Business/ Occupation __________________If so, may it be listed in our CALLBOOK? (Y/N) _______
Type of Application:
[__] Voting Member $22.00 [__] Student Member $8.00[__]
[__] Associate (non-licensed) member $11.00 [__] Family Member $2.00[__]
Additional Members in same family: (Non-Voting, $2.00) (Voting, $22.00)
Name_______________________________ Call_______ Class________
Name_______________________________ Call_______ Class________
Name_______________________________ Call_______ Class________
Are you an ARRL Member (Y/N) _____
TOTAL DUES PAID: $________________
Please make your check payable to: ATLANTA RADIO CLUB, INC.
AUTOPATCH AGREEMENT
(Except in an emergency, the AUTOPATCH is open ONLY to Atlanta Radio Club Members who have a current autopatch agreement on file with the Club).
I agree to abide by the rules and regulations of the Atlanta Radio Club and the FCC for the use of the Club repeaters and AUTOPATCH. I understand and agree that the AUTOPATCH is NOT to be used for business, commercial, or other prohibited purposes, and that the control operators may terminate any call they feel is questionable. If I have questions due to terminated calls, I will contact the Repeater Manager by telephone or in person. I also understand that the use of the AUTOPATCH , EXCEPT FOR EMERGENCIES, has third priority after emergency communications, and regular QSO's. I AGREE THAT THE REGULAR AUTOPATCH CODES ARE PRIVATE AND CONFIDENTIAL, AND I WILL NOT DIVULGE THEM TO ANYONE. (Emergency codes may be made public).
SIGNED: ______________________________ Date: ________ ||| SIGNED: ____________________________ Date: _________
All persons who wish to use the AUTOPATCH must sign this agreement. Parents must sign for minor children.
Form ARC-1 (Rev. 3/02) supercedes all previous revisions.