http://www.aamerican.com/aclr/aclrap.html

ACLR

The Amateur Cross Link Repeater Association
Membership Application

Last Name:___________________________First Name:____________________________MI:_______ Street:___________________________________________________________Apt:_________________ City, State:_____________________________________________ZipCode:_______________________ Home Phone:_____________________________________Birthdate:____________________________ E-mail address:__________________________________Date of Application:_____________________ Callsign:__________________________________Class:______________________________________ Please list all members of your household, including their birthdates.
1.____________________________________________________________________________________________ Last name, First name Birthdate Relationship Call Class 2.____________________________________________________________________________________________ Last name, First name Birthdate Relationship Call Class 3.____________________________________________________________________________________________ Last name, First name Birthdate Relationship Call Class 4.____________________________________________________________________________________________ Last name, First name Birthdate Relationship Call Class 5.____________________________________________________________________________________________ Last name, First name Birthdate Relationship Call Class

Type of Membership: ____Family/Household $30.00 ____Regular $30.00 ____Handicap $20.00* ____Child(under 18) $20.00*

*Handicap must have doctor's statement listing type of handicap. For child membership, the oldest ham in the household must be under 18.

Please mail this completed application, a check or money order for $30.00*; and copies of all ham licenses for your household. After processing your paperwork, your welcome packet will be forwarded to you. If you have any questions please call: (773) 735-6257 or (630) 497-2755 Thank you and welcome to ACLR!

Please mail to:

A.C.L.R.
P.O. Box 352
Bellwood, Illinois 60104-0352