PARS Membership Application

Pittsburgh Antique Radio Society Membership Application/Renewal

Name ________________________________________________

Street ________________________________________________

City ________________________State ______ Zip____________

email_________________________________________________

Phone: _______________________________________________

Text Message Okay?      Y      N

Ham Radio Callsign (if any): ___________________________

Please check one: Renewal [_] New Membership [_]

May we list this information on our roster Yes [_] No [_]

Signature _____________________ Date ____________

Please mail this form with your check for $20 (Payable to PARS) to:

Jeff Pleva
2150 Swallow Hill Road
Pittsburgh PA 15220-1651