Fill this Application out and select the button below to Print Out this Application to Mail in. Please mail Application to:

Wireless Association of South Hills

c/o Mark Stabryla N3RDV, VP/Treasurer

1120 McKnight Drive

Bethel Park , PA 15102-2456

Dues By Quarter
Normal Membership
Membership <18or>65
Associate Membership
1st Qtr (Jan-Mar)
$20.00
$10.00
$10.00
2nd Qtr (Apr-Jun)
$15.00
$7.50
$7.50
3rd Qtr (Jul-Sept
$10.00
$5.00
$5.00
4th Qtr Oct-Dec)
$5.00
$2.50
$2.50
First Name
Email Address
Last Name
Call Sign
Address 1
License Class
Address 2
Expires On
ex. mm/dd/yyyy
City
Birthday
 ex. mm/dd/yyyy
State
Add a Family Member
($3.00 each)
Yes No
Zip
Total Membership Amount
(See Legend Above)
Home Phone
ex. 412-555-1212
List Family Members
Work Phone
ex. 412-555-1212
Today's Date
ex. mm/dd/yyyy
ARRL Member
Yes No
Family ARRL Member
Yes No