Membership Application/Renewal form for OPARC  

You may print this form, fill it out and bring it to the next meeting or mail it, along with your check to:

OPARC PO Box 1029 Orange Park FL 32067-1029

 New Member or Renewal (circle one)

Regular Membership $15
Family Membership $20
Senior (60+) Membership $7.50
Student Membership $7.50

Callsign: __________________________

Last Name: ________________________

First Name: ________________________ MI _____

Street Address: _____________________________

Apt # ____________________

City: ______________________________________

State: _____ Zip+4:__________________

Phone: (_____) ______________________

Birth Month: _________________________

E-Mail Address: ______________________

Family  Members:_____________________
 
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