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,
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.
Please make your check payable to the Indiana Historical Radio
Society (or IHRS) and send this application form to: