PAWA Membership Application

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:

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