Membership Application

AMATEUR TELEVISION NETWORK

MEMBERSHIP APPLICATION &

RENEWAL FORM

Where do membership dues go?

Your generous donation is used to pay for site rent of the ATV repeaters and repair parts.

Each chapter has a separate account for its dues and site rent expenses. Liability

insurance is a shared expense. New members will receive a Membership Certificate.

Associate ATN Membership for ATVers outside existing ATN Chapters is $15 per year

made out to the treasurer of the ATN chapter you want to support.

Please make your check or hand cash to the treasurer of the ATN chapter that you

want to support. Some chapters offer online payment. The name and address are listed below.

I have another ham in the family, is there a discount? Yes, all hams in your family living

at your residence are covered at no additional charge.

NAME________________________ CALL___________ E-MAIL_________________

NAME________________________ CALL___________ E-MAIL________________

ADDRESS_____________________________________________________________

ADDRESS_________________________________________________ ___________

CITY__________________ STATE______ ZIP ____________

PHONE # (will be kept confidential) (______) ______-________