Indiana Historical Radio Society Membership Application

Send this page to a printer, complete the form (please print clearly), and  with a check payable to IHRS,
mail the form to the IHRS Treasurer at he address listed below.

Name _______________________________________   Date _________________

Street (R.R., P.O. Box) ________________________________________________

City ____________________________ State _________________ Zip _________

Phone (      ) ____________________  email address ________________________

Amateur Radio Call _________________________________

Do you have any specialties or particular interests?


Are you a member of other radio clubs? __________

Do you have a current or past affiliation with the radio industry? (If so please tell us.)


Husband and wife, family members, etc. at the same address are one membership.  Dues are $15.00 for one year, in the U.S. 
$19.00 per year for overseas - U. S. funds only.  The membership runs from January 1 to December 31. 
Four IHRS Bulletins are sent to paid members each year.

Please make your check payable to the Indiana Historical Radio Society (or IHRS) and send this application form to:  
Indiana Historical Radio Society, Treasurer     3814 E 400 N     Windfall, IN  46076

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