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Interstate Repeater Society

Amateur Radio Club

Derry, New Hampshire

Membership Application

New Membership Applicants: If you used the PayPal option just print out this form and mail it in.
Renewing members need not send in this form unless you wish to change your personal information

New Member Date:
Renewal / Change

Name: Call Sign(s):
City: State: Zip:
Home Phone:

Amateur License Class:
Membership Dues - September 1st to August 31st each year.
Full Member - $35.00  
2nd Full Member in same family - $10.00
Under 12 Member - Free (send proof of age)

Please make checks payable to:  Interstate Repeater Society  
Or use the PayPal options on the Home page
Either way

Please completely fill out this form print it out and send this application with your check (or if you used the PayPal Payment Just send the application) To:

Interstate Repeater Society
P.O. Box 693
Derry NH 03038
Attn: Membership Committee

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