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YL SYSTEM FIRST TIME MEMBERSHIP APPLICATION

     

Print the form and email it to treasurer@ylsystem.org if paying by PayPal

OR

Complete this form and mail to:

Bill Phillips, W7AJP, 87298 Chinquapin Loop, Veneta OR 97487

NOTICE: All DX sending funds to the YL System are to send (1) a Check via a U. S. Bank in U.S. funds OR (2) Send $21.00 via PayPal to treasurer@ylsystem.org  This can be done via our web site: www.ylsystem.org We cannot accept non-US bank checks.

Make $20 check or money order payable to “YLISSB.” DX stations must use PayPal.

CALLSIGN: ______________ NAME: (AS ON LICENSE)____________________________

ADDRESS:______________________________________________________________

CITY:___________________ STATE:_______ ZIP:________COUNTRY:__________

CLASS OF LICENSE:________________ YOUR NICKNAME:__________________

CURRENT EMAIL ADDRESS:_________________________ WEBPAGE:______________

PHONE NUMBER: _____________________________ (Not published)

BIRTHDAY: MONTH:________ DAY_____ YEAR  ______ (Yr. Optional)

WEDDING ANNIVERSARY: MONTH:_____ DAY ____ YEAR ______ (Yr. Optional)

            OM's or XYL's first name: __________________

ARE YOU A VETERAN? __________  Branch of Service: _____________________

Have you ever been issued an SSB’er number before: YES: ____ NO: ____

If Yes: under what call sign?______________________

ARRL Member?____________

Your Signature: ________________________________  Date: ___/____/____ (mm/dd/yyyy)

 

Revised: 22 Dec 2014

 

CALLSIGN(s) :