Stanford Amateur Radio Club - W6YX

Membership Application

The Stanford Amateur Radio Club is a student organization of Stanford University. Membership is available to all Stanford affiliates, faculty, staff, students, and their families. Membership to non-Stanford affiliates may be granted on a case-by-case basis. More information: http://www-w6yx.stanford.edu

Last Name First Name Callsign Class of License

Home Address (Street, City, ZIP) No P.O. Boxes, please.

Business Address (Name of Employer, Street, City, ZIP)

Telephone Contact Information:
Home: _______________ Cell: _______________

Work: _______________ Fax: ________________

E-Mail:

Stanford Affiliation:

I am affiliated with Stanford University (incl. all Stanford-related entities such as Hoover, SLAC, etc.):

[ ] undergraduate student - major:

[ ] graduate student - department & advisor:

[ ] faculty/staff - department/title:

[ ] other Stanford affiliate (family member, etc.):

[ ] alumnus/ae - degree(s)/year(s):

[ ] Non-Stanford Member - please explain why you should be granted Associate Membership:

I Am Interested in: (check all that apply)

[ ] Emergency Communications; [ ] DXing; [ ] VHF phone; [ ] Satellite; [ ] ATV; [ ] digital communications; [ ] Other: ________________ Please enclose a check for $50 (free if you are a current student) payable to STANFORD AMATEUR RADIO CLUB. You may also enclose a separate tax-deductible donation.

New members: You must turn this form in IN PERSON at a meeting of the Stanford Amateur Radio Club (see http://www-w6yx.stanford.edu/ for meeting location and times). Renewals may be mailed in to the address below. Membership is subject to the approval of the club membership.

Return Form to: Stanford Amateur Radio Club (W6YX) • P.O. Box 19212 • Stanford, CA, 94309