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Membership Form
I hereby apply for membership for the Organization/Person named below in the INDIANA REPEATER COUNCIL and in doing so agree to abide by the rules and regulations as stated in the Constitution and By-Laws. Enclosed are dues in the amount of $8.00 per year. Please retain a duplicate for your files. (This information will be considered current until the Secretary is so advised by you.)
Name of Individual or Group :____________________________________________________________________
Preferred Mailing Address :______________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
City State Zip
Repeater(s)
Sponsored: Call_____________Freq._______________Location________________________________
Call_____________Freq._______________Location______________________________
Call_____________ Freq. ______________ Location_____________________________
Representatives who carry the voice and vote of our Organization:
Representative:_______________________________________Call______________________________
____________________________________________________________________________________________
Address City Zip
____________________________________________________________________________________________
Telephone Packet BBS Monitored
(Alt.)Representative:_________________________________________________Call______________________
____________________________________________________________________________________________
Address City Zip
____________________________________________________________________________________________
Telephone Packet BBS Monitored
Applicant's Signature________________________________________________________Date_______________
Send to: Indiana Repeater Council Date Received______________________
C/O Indiana Repeater Council Inc. P.O. Box 501642 Dues Included? _________________
Indianapolis, IN 46250 Approved by Council _________________
Revised Jan. 2003
MEMBER OF M.A.C.C. / N.F.C.C.
Indiana Repeater Council