Amateur Radio Lighthouse Society
I wish to apply for a new ARLHS / ILLW membership at the Basic Level. I understand that this level offers a lifetime ARLHS member number and authority to use the ARLHS logos on QSLs and on stationery and other media, such as web sites and stationery. I further understand that web site privileges are limited at this membership level and that after the initial registration, there are NO additional fees or annual dues.
Name __________________________________________ Call Sign ___________________
Street Address ________________________________________________________________
City ______________________________________ State / Province ____________________
Postal Code / ZIP ___________ Country ___________________ Telephone _____________
E-Mail Address ___________________________________
Date of Birth (DD/MM/YYYY) _____________
I agree to a one-time registration fee of US $5.00 (Canada and USA) or $7.50 (outside of USA).
I understand that there are NO further payments or yearly dues unless I change my member status.
I have read and agree to the conditions and terms as outlined above. Enclosed is my registration payment in the amount of $__________ in the form of cash ______ , money order # __________________, or check # ___________.
If you have any questions, you may call 856-486-1755 during business hours, 9 AM— 5 PM Eastern
Please send this form, along with your payment, to:
The Amateur Radio Lighthouse Society
Headquarters — Memberships
114 Woodbine Avenue
Merchantville, NJ 08109-1854