MaIaysian Amateur Radio Transmitters' Society

National Society for Amateur Radio since 1952

A Member of the International Amateur Radio Union

MEMBERSHIP FORM
(I ndividual & Family*)

New Application Renewal, membership no. ... Previous/Lapsed Member Record Update
1. PERSONAL INFORMATION
Name: Call Sign(s): Ex Call Sign(s):
Preferred name or Handle: Salutation: Principal Members Name & Call Sign (for Family Membership):
Address:
Postcode & City: State/Province/Prefecture: Country:
Home Phone No.: Mobile Phone No.: Fax No.: Work or Other No.:
e-Mail Address: Personal Web Site URL:
http://
Date of Birth (dd/mm/yyyy): Gender:
M F
Malaysian Identity Card
New No.: Old No.:
Non-Malaysian
Citizenship: Passport No:
Present Profession: Organization:

2. FEES
Entrance (for new or pervious/lapsed membership) RM20
Transmitting Membership (for 9M or 9W license holder) RM50 x year(s)
Transmitting Membership (Family)*
Spouse/Unmarried Childs Name & Call Sign: ....
Unmarried Childs Name & Call Sign: .......

RM25 x year(s)
RM25 x year(s)

Associate Membership (for Short Wave Listener in Malaysia, Singapore, Brunei) RM25 x year(s)
Associate Membership (Family)*
Spouse/Unmarried Childs Name: ............
Unmarried Childs Name: ....

RM12.50 x year(s)
RM12.50 x year(s)

Associate Membership (International) (except for Singapore, Brunei) RM32 x year(s)
Total
* resides at the same address as the primary member, please also submit an additional membership form per family membership with
Personal Information and Declaration of Applicant/Member sections duly completed

3. PAYMENT
I enclose a cheque/postal order/money order, no. , drawee bank/PO ...,
of RM, made payable to Malaysian Amateur Radio Transmitters Society

4. DECL ARATION OF APPLICANT/MEMBER
I declare that the above information given is true and correct, and this application is subject to the national councils approval.


Applicant/Members Signature:
Date (dd/mm/yyyy):


New transmitting membership appIication to attach a copy of Apparatus Assignment

Send to: MARTS, PO Box 10777, 50724 KuaIa Lumpur, MaIaysia Fax:+603 6272 7708 e-Mail: cmthiam@gmail.com

MARTS ADMINISTRATOR'S USE
Received by & date: Data Entry by & date: Receipt no.:

MARTS Form A
,
May 2010
To Bank in Maybank Account No:5-14093-22069-6 (Please Write Your name and callsign on the bankin slip and forward it to the Secreatry)