Pikes Peak FM Association
Membership Application
Please complete application below, and send your check or money order (payable to PPFMA) for the appropriate amount for annual dues to:

Pikes Peak FM Association

P.O. Box 7787, Colorado Springs, CO 80933-7787

New Member Dues Proration Table
Based on the month you join
(New members, circle the month you're joining and pay the amount below it)
Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb
$20.00 $18.35 $16.65 $15.00 $13.35 $11.65 $10.00 $8.35 $6.65 $5.00 $3.35 $1.65
For subsequent renewals you'll always pay $20 in March.
All dues are due by March 31.
Check type of membership:   New? [   ]   Renewal? [   ]   Change? [   ]

  
Name/Callsign: _________________________________________________
  
Are you an ARRL member? _________________________________________________
  
Address: _________________________________________________
  
City/State/ZIP: _________________________________________________
  
Phone: ___________________________Include in roster   (circle one)?   Y   N
  
E-mail Address(es): _________________________________________________
(Will be added to our info mail list) _________________________________________________
  
Licensed family
members (indicate
which are ARRL members):		 _________________________________________________
  
  _________________________________________________
  
  _________________________________________________

FAMILY MEMBERS: Licensed family members residing in a FULL member's household may be registered as "Family Members" and have autopatch privileges at no extra charge. "Family" members may not hold office. A "Family" member may only vote if his or her "Full" member is absent. One vote per Full membership.