TABLELANDS RADIO & ELECTRONICS CLUB Inc.
PO Box 682 Atherton QLD 4883
Email vk4wat@wia.org.au
APPLICATION FOR MEMBERSHIP
Name of Applicant:
Callsign:
Postal Address:
Residential Address :
Mobile Phone:
Home Phone:
Email:
Are you a WIA member?:
Interests in Amateur radio?
Proposer:
Callsign:
Signature:
Seconder:
Callsign:
Signature:
Membership Class: Ordinary
$35.00 Associate: $25.00
I the above named applicant wish to become a member ( class of membership shown above )of the
Tablelands Radio & Electronics Club Incorperated.
I understand the fee for membership is payable on submitting this application and if such application is
rejected the total fee will be refunded to me.
Once becoming a member of the club, I hereby agree to be bound by the Rules and Regulations and
Constitution of the Club.
Signature of Applicant: Date: / /
OFFICE USE ONLY
Acceptance Date: / / Fee received: Data entered in Data Base:
VK4SDD 2021