Basic Membership

in the

Amateur Radio Lighthouse Society

PLEASE PRINT

 

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