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Interstate Repeater Society

Amateur Radio Club

Derry, New Hampshire

Membership Application


New Member Date:
Renewal / Change


Name: Call Sign(s):
Address:
City: State: Zip:
Home Phone:
 E-Mail          
Amateur License Class:
 
Membership Dues - September 1st to August 31st each year.
Full Member - $25.00  
2nd Full Member in same family - $10.00
Under 12 Member - Free (send proof of age)

Please make checks payable to: Interstate Repeater Society

Please completely fill out this form and
print out from your browser at home.

Please send this application and your check to: Interstate Repeater Society
P.O. Box 693
Derry NH 03038
Attn: Membership Committee.