Ellijay Amateur Radio Society logo W

Membership Form
Ellijay Amateur Radio Society
PO Box 1371
East Ellijay, GA 30539

Name: ______________________________________________________ Call Sign:________________________


City:___________________________________ State:__________________________ Zip Code:_______________

Website: http://___________________________________________ Email:________________________________

Home Phone (____) _______________ Work Phone (____) _______________ Cell Phone (____) _______________


Circle Bands you can work. 160m 80/75m 40m 30m 20m 17m 15m 12m 10m 6m 2m 1.25m 70c/440 902mhz&higher

What digital modes are you capable of operating?______________________________________________________

Can you operate CW ?_____________ Do you have facilities at home QTH for CW ?_________________________

Do you have emergency power. if yes what type? (batteries or generator)_________________________________________

What license class are you?_________________________ Do you have Skywarn training?_____________________

Are you a member of  ARRL?______ Are you a member of  RACES/ARES?______ MARS call if any?___________

Do you have HT's, if yes what band(s)?______________________________________________________________

Do you have Mobiles, if yes what band(s)?___________________________________________________________

Number of computer(s) (zero for none)_____Desktop _____Laptop. Internet access type if any? Dialup or DSL/Cable

Do you have a Weather Station?_____________ Do you have a NOAA Weather Radio?________________________

Can you operate at the 911 center during an emergency? If yes give  preferred hours:________________________

Are you interested in teaching an Amateur Radio class?(elmer)________________________________

Could you help as a VE (volunteer examiner)? If yes what months?___________________________________________

Are you interested in a local Net?________ Would you be willing as Net Control operator?______________________

Would you be interested in doing a demonstration or program at a Club meeting?_____________________________

"I have received a copy of the EARS by-laws and agree to abide by the rules and statutes therein and that shall from time to time be amended, approved and published by the EARS membership. I further stipulate by signing below that I have never been convicted of a felony involving moral turpitude under federal law or laws of the several states."


(Return form and $30 Dues to above club address. Make checks payable to E.A.R.S.)