OCRG - Printable Membership Form

Ocean County Repeater Group
P.O. Box 525, Toms River, NJ 08754

Please print this page and mail it along with your check or money order to the address above. All checks and money orders are to be made payable to "CASH".

Name __________________________________________ Call ______________

Address __________________________________________________________

City _____________________________ State _______ Zip _________________

Home Phone _______________________

May we print this number in our Membership roster? (Y/N) _____

Phone number for Auto Dial (if full member) _______________________

E-mail or Packet address _______________________________________

Occupation ___________________________________________________

License Class __________ Year First Licensed __________

ARRL Member? (Y/N) _____ ARES Member? (Y/N) _____

Other Amateur Organizations _________________________________________

Interests: (please circle all that apply)

CW AM SSB FM RTTY SSTV ATV Packet RACES Traffic MARS Contests Satellite DX Other ____________________________

Bands Operated:

160 80 40 20 15 10 6 2 220 440 Other _______________________

Donation:

_____ $25 Full Membership (with Autopatch)

_____ $15 Contributing Membership (without Autopatch)

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