[ ] Full Membership ($25.00/year) [ ] Associate Membership ($15.00/year) [ ] Student Membership (Free) [ ] Senior Membership (65 years and older - $10.00/year) [ ] Family Membership ($30.00/year)
I agree to abide by the Constitution and By-Laws of the Peekskill / Cortlandt Amateur Radio Association, Inc. Signature: _________________________________________ Date: ______________________________
APPLICANT - PLEASE DO NOT WRITE BELOW THIS POINT
Application Received by: ____________________________ Date: ______________________________