IEEE MOVE Radio Club Application

Required fields are marked with a red *. Information supplied will be viewable by MOVE Radio Club Members. You will be asked to confirm this at the end of the application. Applicants that are both licensed Amateur Radio operators and IEEE members will be Full Members. All others are welcomed as Associate Members.

Call Sign

Enter in all caps, use NONE-LASTNAME if no call sign

Nickname

Preferred informal name

Prefix

First

Middle

Last

Suffix

License Class

(Volunteer Examiner)

DMR ID

IEEE #

Red Cross #

Address Lines

{name}

City

State

Use 2 character abbreviation

Country

"United States" if appropriate

ZIP

Phone Mobile

Phone Work

IEEE email

Red Cross email

GMail

Preferred email

OPS Class

Enter date of most recent completed class

DST Class

AUXCOMM Class

Certificates

{name}

Picture

Attach file

Drop files here

Interest

{name}

Experience

{name}

Bands

Modes

AgreeMbrView

I agree that the information that I have supplied can be collected and displayed to MOVE Radio Club Members.

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