• Please provide the following information by completing the form:

  Full Name
  Call Sign
  Street Address
  Address (cont.)
  City
  State/Province
  Zip/Postal Code
  Work Phone	(include area code)
  Home Phone	(include area code)
  E-mail (Req'd)
  Drivers Lic #	(For N6IJ Door Lock Card Reader)

• Does your driver's license have a magnetic stripe on its back?

Yes, it has a magnetic stripe
No, it doesn't

• Membership Category:

  Regular ($25)
  Full Time Student ($15)
  Under 16 yrs. ($5)
  

• The N6IJ station costs almost $2,500 a year to operate at a basic level. To make the station accessible to all we have intentionally kept membership dues low. If you would like to make an additional donation to the club for operating costs and station improvement please enter it below and add it to your dues amount when paying.  If you make a donation, please note it in the comments section. 

• Thank you - we really appreciate the help!

    Donation Amount
  

• Amateur Radio license class:

  Technician
  Technician +
  General
  Advanced
  Extra
  

• Number of Years Licensed?

  
  

• ARRL Member?

  Yes No
  

• What are your radio interests? What would you like us to do with N6IJ?

  
  

• Are you interested in volunteering to help with improving and maintaining the station or donating equipment? If so, how?

  
  

• Other comments or questions?

  
  

• Payment Method:

  On-Line with Credit Card (see below)
  Via Mail
  In Person to a MBARA Officer / Board Member
  

Payment via check (mail), or cash at a MBARA or local ham club meeting:  Just print out this form after you have filled it out and then press submit so we will receive a copy. Then just skip the payment page when it comes up. Please include a printed copy of the completed form when you submit your payment via the mail or in person. You may mail your renewal form and payment to:

Jeff Ackerman, MBARA Treasurer

Please make checks payable to: MBARA

Include your call sign (if any) on the check.

SUBMIT   (This will take you to the payment page.)