Pittsburgh Antique Radio Society Membership Application/Renewal

Name ________________________________________________

Street ________________________________________________

City ________________________State ______ Zip____________

Please check one: Renewal [_]   New Membership [_]

May we list this information on our roster Yes [_]    No [_]

Signature _____________________ Date ____________

Please mail this form with your check for $10 (Payable to PARS) to:

Tom Dixon
448 S. Meadowcraft Avenue
Pittsburgh, PA 15228