THE U.S.A. POLICE RADIO CLUB NETWORK
& INTERNATIONAL POLICE ASSOCIATION RADIO CLUB


MEMBERSHIP APPLICATION

DATE______________________________    CURRENT VALID FCC CALLSIGN________________________

NAME__________________________________________   IPA / IPARC # _____________________________

DATE OF BIRTH ___________________________________

ADDRESS ________________________________   CITY  __________________________________________

STATE  ___________________   ZIP  ________________  COUNTRY_________________________________

PHONE / FAX #  _______________________________  E MAIL ADR.  ________________________________

STATE BRIEFLY YOUR LAW ENFORCEMENT BACKGROUND, IF ANY:  _____________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

IPARC membership # s are assigned by the RADIO CLUB SECRETARY / TREASURER.
Dues are $15.00 per year - (July to July) This includes yearly subscription to the
National Monitor Newsletter

Fill out Application and mail to:

                                                                               Frank Dlugokinski,  WA1ECA
                                                                               154 West St.
                                                                                POB 772
                                                                                Litchfield,CT 06759
E Mail: fdugo@snet.net
Foreign Postage please add $5.00 US         Please write your callsign on your check

(To Print out form go to File, then to Print, select to print page containing this form)

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