Membership Application & Renewal Form

__ New Application __ Renewal If renewal, enter your ECARS No: __________

Call Sign __________ License Class _______ Year First Licensed __________

Name ___________________________________________________________

Street ___________________________________________________________

City / Town _______________________________ State / Province _________

Zip / Postal Code ________ - ______ Home Phone (____) ______ - _________

ARRL Member: __Yes __ No Year you first joined ECARS ________________

E-mail address (do not use alias, e.g. @arrl.net)_________________________

May ECARS publish your e-mail address? __ Yes __ No

ECARS Dues: __ 1 year $10.00 __ 2 years $20.00 __ 3 years $30.00

Voluntary donation for a better ECARS: __ $1 __ $5 __ $10 __ Other: ______

I, the undersigned, hereby request new or continued membership in East Coast
Amateur Radio Service, Inc.

I agree to abide by ECARS Bylaws, a copy of which is available for my review on
the ECARS web site www.ecars7255.com prior to my submitting this application.

I understand that my application for ECARS membership is subject to approval
by the ECARS Board of Directors, in its sole discretion.

Signature _________________________________ Date ________________

Instructions: Complete this form and mail it with a check or money order in
United States funds to:

ECARS, Inc.
P.O. Box 5923
Hudson, Florida 34674-5923