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Until we can get a .pdf document, please print out this temporary application form.

SOUTH FLORIDA FM ASSOCIATION
PO Box 430028
Miami, FL 33243

A NOT FOR PROFIT CORPORATION ESTABLISHED 1968 DEDICATED TO SERVING RADIO AMATEURS AND THE COMMUNITY 

THE SFFMA MEETS THE SECOND MONDAY OF EVERY MONTH AT 7:30 PM AT THE MIAMI-DADE E.O.C.

Today's date__________________________

Call Sign ______________  License Class ___________________ Exp  date __________________
Name (print) ___________________________    Spouse (child) names & Call__________________________
Address_________________________________________________________  Apt #__________________
City __________________________________ State_____________ Zip ___________
Telephone: 
Home__________________ Office __________________ Fax __________________ Cellular __________________
E-mail Address: __________________________ @ _________________________________
Home________________________________________:____________________________ _
Member ARRL? (please circle) YES NO


Dues Structure This Application to be accompanied by first years dues and one time initiation Fee.

Membership Year: October 1 through September 30 (initial dues pro-rated in second year). 

Initiation fee, $10, Annual Dues, $30 = Total $40. 

Additional Family Members, $5 each, MEMBERS RESIDING OUTSIDE OF TRI-COUNTY AREA $15 SEND APPLICATION TO ABOVE ADDRESS 

Check Here____ $1 Voluntary contribution to ARPSC enclosed with payment of Dues 

Applicant hereby agrees to abide by the Constitution/By-Laws of the Association

Applicants signature______________________________________  DATE___________
Please attach a copy (not original) of Applicants FCC License Name

Signature of Sponsor _________________________ CALL _________________Date ___________
Sponsor Name (Print) _____________________________________________

AREAS OF INTEREST IN ASSOCIATION ACTIVITIES
_______ Administration (officer, newsletter, repeater trustee, etc)
_______ Emergency service (hurricanes and other emergencies)
_______ Instruction (classes for beginners, upgrading)
_______ Legislative ( City, County. State, federal)
_______ Programs (meetings, social acivities, Planning)
_______ Public Rlations
_______ Special events (parades, Races, Other)
_______ Technical (repeater planning, Support
_______ CHAMP/CITIZENS HAM MOBILE PATROL

VHF/UHF EQUIPMENT OWNED:  __ BASE __ MOBILE __ HANDHELD
OTHER EQUIPMENT: __ HF __ PACKET __ SSTV __ 50 MHz __ 220 MHz __ 1.2 GHz

The South Florida FM Association, with the Metro-Dade Police Department and Citizen crime watch, Co-Sponsor: CHAMP, The CITIZENS" HAM AMATEUR MOBILE/MARINE PATROL

03/02/2004 12:29:01 PM

    South Florida FM Association, 2003   
   

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