TABLELANDS RADIO & ELECTRONICS CLUB Inc. PO Box 682 Atherton QLD 4883 Email 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