Green Mountain Repeater Association
Membership Application
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Instructions: Enter the fields below and then click the "Submit" button at the bottom of the screen.  This will send your application
but not the required membership fee.  Once submitted, you will receive an invoice via email for online payment.

  
 
  
Call Sign
License Class
 
Green Mountain Repeater Association
NEW MEMBER APPLICATION FORM
First Name
Middle Name
Last Name
Suffix
Address
City
State
Zip Code
Home Phone
Work Phone
Cell Phone
Email Address (Required)
Occupation (for statistics only): Are you an ARRL Member?
 
Family Members: (You can add up to 3 additional hams living in the same household at no additional charge)
First Name
Last Name
Call Sign
Lic Class
Email Address
First Name
Last Name
Call Sign
Lic Class
Email Address
First Name
Last Name
Call Sign
Lic Class
Email Address
Notes: (Anything you want to tell us about this application?)
The Membership Fee is $30.00.    Soon after you submit this form, you will receive an invoice in the amount of $30.00, which can be paid online via credit card or PayPal account. Some members also like to make a donation (not required) to our equipment fund.   Typical donations are in the amounts of $5, $10, $15, $20, $25, $30, $35, $50, or any other amount. If you wish to make a donation, please enter it in the box below, and it will be included on the invoice.
Membership Fee Amount ($30.00):
Donation (if any): Invoice Total: $
      After submission of this Membership Renewal Form, you will receive an invoice for payment by email. Payment can be made online via credit card or with a PayPal account.
By submitting this application you agree to abide the the Green Mountain Repeater Association's Rules & Bylaws, available on the GMRA website.
             
Call Sign
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License Class
{LIC_CLASS}
Green Mountain Repeater Association
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First Name
{FIRSTNAME}
Middle Name
{MIDDLENAME}
Last Name
{LASTNAME}
Suffix
{NAME_SUFFIX}
Address
{ADDRESS}
City
{CITY}
State
{STE}
Zip Code
{ZIP}
Home Phone
{HMPHONE}
Work Phone
{WKPHONE}
Cell Phone
{CELLPHONE}
Email Address (Required)
{EMAIL}
Occupation (for statistics only): {OCCUPATION} Are you an ARRL Member? {ARRL_MEMBER}
Family Members: (You can add up to 3 additional hams living in the same household at no additional charge)
First Name
{FAMILYFIRSTNAME_1}
Last Name
{FAMILYLASTNAME_1}
Call Sign
{FAMILYCALLSIGN_1}
Lic Class
{FAMILYLICCLASS_1}
Email Address
{FAMILYEMAIL_1}
First Name
{FAMILYFIRSTNAME_2}
Last Name
{FAMILYLASTNAME_2}
Call Sign
{FAMILYCALLSIGN_2}
Lic Class
{FAMILYLICCLASS_2}
Email Address
{FAMILYEMAIL_2}
First Name
{FAMILYFIRSTNAME_3}
Last Name
{FAMILYLASTNAME_3}
Call Sign
{FAMILYCALLSIGN_3}
Lic Class
{FAMILYLICCLASS_3}
Email Address
{FAMILYEMAIL_3}
Notes: (Anything you want to tell us about this application?)
{TEMPNOTES}
{_UNBOUND_STATICTEXT_4}
Membership Fee Amount ($30.00): {MEMBERSHIP_FEE}
Donation (if any): {DONATION} Invoice Total: $ {TOTAL_FOR_GRID_ONLY}
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{_UNBOUND_STATICTEXT_2}
 
 
 

  
 
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