KD4RAA-K4JDR Repeater Group
Supporting Membership Form

Please complete the following form and submit for review (* - required).

Name *

Callsign *

Address *

City *

State * Zip *

Day Phone *

Night Phone *

Fax #

Cell Phone

Year of Birth * Today's Date *

Personal Email *

Personal URL

Enter desired AutoDial
Phone Patch Number

Vocation

Do you already know anyone
in the KD4RAA Group? (list) *

Key Reason for Joining
the KD4RAA Group *

Area Clubs or Organizations *

SERA member? * Yes No

ARRL member? * Yes No

Ham Interests

Technical Skills you can
contribute to the group

How did you hear
about us or IRLP? *

Comments

Select one of the following options for suggested yearly donation:

Associate Membership (repeater use only, no user or IRLP codes) - $10

Autopatch and User Codes for UHF linking system - $15
IRLP node-to-node access codes - $15
Full Support Membership (all access) - $25
Repeater owners and trustees
(note: no funds will be collected at time of submission)

All financial support is targeted to help offset the operational and maintenance cost of the repeater linking projects and leased line access. If you are not financially able to participate in supporting the repeaters and links, please give the reason why in the "comments" field. We have made provision for scholarship opportunities for those qualifying.

Renewal to membership will start in January-March of each year.

Ronnie J. Casey, K4JDR will contact you by return email or by phone about membership dues and information on the systems.

Thank you for supporting the Link System and Internet Radio Linking Project.

Form will only be sent to Control Operators for review.

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KD4RAA-K4JDR Repeater Group Supporting Membership Form

KD4RAA-K4JDR Repeater Group
Supporting Membership Form