Name_____________________ Call______________ Date_______________
Address_______________________________________ City________________________
State_________________ Zip Code _____________________
License class (check one)
_______Amateur Extra ______Advanced ____General ____ Tech. _____Novice
Phone(H) ________________ Cell_________________
ARRL member? Yes______ No_______
E-mail address__________________________________
Do you have Web access? Yes____ No ____
Web Site: www.pawa-maine.org
Are you newly licensed(within last 12 months)? Yes____ No____
Date licensed__________________(free calendar year Associate membership of
newly licensed within last 12 months)
Membership dues are: 1) Full membership $15.00/yr 2) Family membership
$22.50/yr(incl all licensed hams in immediate household). 3)Student membership
$7.50/yr / Associate !membership $7.50/yr(no voting privileges).
I am applying for membership as:
____Full member. ____Family member. _____Associate member _____Student
Return Application with dues (checks made out to: PAWA)
Return to: PAWA 19 Birchwood Drive Portland,Me 04102