Bushvalley ARC Application Form

Bushvalley Amateur Radio Club Application Form

United Services Club, Limavady www.bushvalley-arc.co.uk
Type of Application?

Membership RenewalNew Membership
Name*

First NameLast Name
Preferred Name*
Address*

Street Address

Street Address Line 2

CityCounty

Postal Code
Phone Number:*
Email*
example@example.com
Sex*

MaleFemale
Call sign:
If a SWL please put SWL in this section.
Application for year:*
Adult / Junior?*

Adult Membership £20Junior Membership FREE
By pressing submit, you allow the club to use the above information for internal use only. Your application has not yet been approved or Declined however, it is pending with the club's committee.

The club's secretary will get back to you as soon as possible.

Please Note: The club's committee has the right to refuse any application.
Comments / any allergies or health conditions you would like to share with the club.
Should be Empty:

Bushvalley Amateur Radio Club Application Form