* NOTE: If you are [Renewing] or submitting a [Data Change] please provide your call sign, name, and any information that is changing. There is no need to re-enter information that is not changing.
Today's Date
Application Type*
Call Sign*
Last Name*
First Name*
Nickname
Spouse / Sig Other Name
Street Address
City
State
Zip
Home Phone Num
Cell Phone Num
Email for Roster and club notifications
We use an invite only Groups.io group for club members only. With your membership you will receive an invite to the group.
Email for your Groups.io invite (Leave blank to use the above email)
License Class
Date originally licensed (When did you become a Ham)
License Exp Date
Are you an ARRL Member?
Are you a VE?
Do you use System Fusion on the FRRL's repeater?
Are you a member of the FRRL Message Group? (Groups.io)
FAMILY MEMBERSHIPS ONLY: Family Membership Information: List family member information
Family Mbr 1: Name
Family Mbr 1: Call Sign
Family Mbr 1: Email
Family Mbr 2: Name
Family Mbr 2: Call Sign
Family Mbr 2: Email
Family Mbr 3: Name
Family Mbr 3: Call Sign
Family Mbr 3: Email
Family Mbr 4: Name
Family Mbr 4: Call Sign
Family Mbr 4: Email
MEMBERSHIP TYPE: Please select an appropriate membership type: (NOTE: Do this again in [Step 2] at the Pay Now button):
FRRL Annual Dues: (and optional $10.00 Repeater support)
Comments
Check the box to verify you are not a robot then press [Submit] to send this to the treasurer. You can then select the same payment options in the PayPal selection and pay online.