Membership Application/Renewal form for OPARC

You may print this form, fill it out and bring it to the next meeting or mail it, along with your check to:

OPARC
PO Box 1029
Orange Park FL 32067-1029

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New Member or Renewal (circle one)

Regular Membership $15

Family Membership $20

Senior (60+) Membership $7.50

Student Membership $7.50

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Callsign: __________________________

Last Name: ________________________ First Name: ________________________ MI _____

Street Address: ______________________________________ Apt # ____________________

City: ______________________________________ State: _____ Zip+4:__________________

Phone: (_____) ______________________ Birth Month: _______________________________

E-Mail Address: _______________________________________________________________