Montreal Amateur Radio Club

MEMBERSHIP APPLICATION FORM 2021 / 2022
(Membership year is September 1 to August 31)

Is this a new membership application or a renewal?

New Membership Application

Membership Renewal

Check if information from last year is correct.

If your information from last year is unchanged, you only need to fill your name and callsign below.

Last Name:

First Name:

Callsign:

Address:

City: Prov:

Country: Postal code:

Home Phone:

Work phone: ext.:

E-mail:

If you prefer your Marcogram to be sent by Canada Post there is a $10.00 charge to cover the postage costs.

Single membership ($30.00)

Family membership ($35.00+$3 per additional person)

MarcOgram sent by Canada Post ($10.00)

Call or name of family members, one per line:

If you are a first time member, who introduced you to MARC:

Are you a member of Radio Amateurs of/du Canada (RAC)? YES NO

Date: 2022-06-30