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BROCKVILLE AMATEUR RADIO CLUB INC.

ANNUAL MEMBERSHIP RENEWAL AND NEW MEMBERSHIP APPLICATION FORM

1 JULY 2025 – 30 JUNE 2026 SEASON

Application Date

Membership Type:
Renewal
New Member

CONTACT INFORMATION

(Only Name and Call Sign (if you have one) are mandatory; all other fields are optional.)

Call Sign
First and Last Names
Address Line 1
Address Line 2
City / Municipality
Province / State
Postal Code / ZIP
Phone
Email
Emergency Contact – Name
Relationship to You
Emergency Contact – Phone

SIGNATURE

Signature
Date

SIGNATURE OF PARENT / GUARDIAN

(If applicant is under 18 years old)

Signature
Date

Special Note: Students not yet in Secondary School should be accompanied by a responsible adult at all BARC events.

2025 – 2026 FEE SCHEDULE

Membership Type Fee
Member of Radio Amateurs of Canada $15.00
Not a Member of Radio Amateurs of Canada
(Includes $14.00 RAC insurance)
$29.00