Date
Name
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Address2
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How long have you been a Ham
Have you ever been convicted of a crime ( Excluding Traffic Offenses )? If so Please Explain.(I.E., Date of
conviction, type of conviction, county or city, court, ETC.) Note: Giving false information on this application
will result in immediate dismissal from the club or your not being considered for membership, whichever
applicable. Please enter your answer below.
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I agree to the above (typing name in this box is the equivalent to your signature.)
Russell County Amateur Radio Club, Inc.
Membership Application
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