SIERRA INTERMOUNTAIN EMERGENCY RADIO ASSOCIATION,INC.
P.O. Box 2348, Minden, NV 89423
Attn.: Membership Chairman

MEMBERSHIP APPLICATION OR RENEWAL



NAME_____________________________CALL______________CLASS___________
BIRTH DATE ____/____/____         ARRL MEMBERSHIP EXPIRES ____/____/____
E-MAIL ADDRESS:_______________________________

NAME_____________________________CALL______________CLASS___________
BIRTH DATE ____/____/____         ARRL MEMBERSHIP EXPIRES ____/____/____
E-MAIL ADDRESS:_______________________________

NAME_____________________________CALL______________CLASS___________
BIRTH DATE ____/____/____         ARRL MEMBERSHIP EXPIRES ____/____/____
E-MAIL ADDRESS:_______________________________

MAILING ADDRESS_____________________________________________________
________________________________________________________________________

PHYSICAL ADDRESS_____________________________________________________
_________________________________________________________________________

HOME PHONE_______________________WORKPHONE________________________

Dues:		Class		1 year	2 years	3years	No. of Votes
		Individual	$24.00	$42.00	$59.00	1
		Household	$32.00	$56.00	$78.00	2
		Added Family     $8.00	$14.00	$19.00	1
		Age <18	no fee	(with license)	       	1

Notes:	"Household" membership consists of two adults at the same
address. "Added Family" memberships are for each additional family 
member at the same address.  Yearly dues are due 1 January.  Dues
are prorated on a monthly basis on initial membership only. 
Contact membership chairman, Bill Lewis, KD7NIR,  775) 782-6949 
for proration schedule. 



______________________________________  ____/____/____  Enclosed $____________
	Applicant  or Member	                          Date

If you have any suggestions for club improvement or any talents that would
help the club members or the club, please note below.

Revised 02/08/2004