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Milwaukee Repeater Club
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Club Membership Application
Use the following form to join or renew your membership with The Milwaukee Repeater Club.
Club Address
The Milwaukee Repeater Club, INC P.O. Box 511566 Milwaukee, WI 53201
Membership Year
*
Application Type
*
New $20.00
Renewal $20.00
Membership Type
*
Individual
Family
MRC Name Tag
Name Tag $8
Send US Mail $4
Are you currently an ARRL Member?
*
Yes
No
Email Newsletter?
Yes
Additional Info Placeholder
If Family: Please list the names, calls, and other pertinent information on any family members living at the same address who are Hams and desire to become MRC members. The $20.00 dues payment covers an entire family for MRC membership.
Name
*
First
Last
Call Sign
*
License Class
*
Email address
*
Date of Birth
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1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
year
Family Member Name
First
Last
Family Member Call Sign
Family Member License Class
Email address for Family Member
Family Member Date of Birth
01
02
03
04
05
06
07
08
09
10
11
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13
14
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20
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29
30
31
day
/
January
February
March
April
May
June
July
August
September
October
November
December
month
/
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
year
Additional family members
Address
*
Street Address
Street Address Line 2
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Congo (Brazzaville)
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wales
Yemen
Zambia
Zimbabwe
Country
Phone
Alternate Phone
Do you agree to abide by our repeater etiquette guidelines? (see website under repeater info)
*
Yes
No
Signature
*
Todays Date
*
Closing
Your membership will be voted on at the next membership meeting once the application is received. THANK YOU FOR SUPPORTING THE MILWAUKEE REPEATER CLUB! Clicking submit will take you to PayPal, Your membership includes $2 dollars to cover the processing fee for renewing online.
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