Membership Application First name Surname Address Occupation Callsign Date of Birth Phone Working With Children Number Email Are you a WIA member? YesNo WIA Membership Number Are you a member of any other Amateur Radio Club or Association? YesNo Other Club Name(s) Amateur Radio Interests HFVHFUHFATVSSTVDXCWDigitalSatellitesContesting Select your membership rate Full Rate Full Rate (6-12 months) $25.00Full Rate (1-6 months) $12.50 Pensioner/Senior/Student Rate Concessional Rate (6-12 months) $18.00Concessional Rate (1-6 months) $9.00 An administration fee of $1.00 applies to all new applications. I hereby wish to apply for membership to the Fisher’s Ghost Amateur Radio Club, and agree to abide by the terms of the Constitution of the Club and such by-laws as may be in force from time to time. I will accept the committee’s decision on the outcome of this application. I am aware that the activities of the Fisher’s Ghost Amateur Radio Club involve the use of electricity and electrical equipment, and that there are dangers inherent in the use of such equipment, and I absolve the Club from any liability arising there from. I confirm that all the details I have provided in this form are accurate. My full name typed below is equivalent to my signature. Full name Δ
