Given Name

Surname

Phone number

Email Address

Street Address 1

Street Address 2

Town or City

Post Code

Postal Address 1 (if different to your street address)

Postal Address 2 (if different to your street address)

Postal Town or City

Post Code

How did you hear about the HRSA?

Your radio experience. Please let us know a little about your experience with radios.

Check a radio button if you do or do NOT what your contact details disclosed to other members. Check a radio button if you do or do NOT what your contact details disclosed to other members. Yes, I authorise for my contact details to be disclosed to other members. No, I do NOT authorise for my my details to be disclosed to other members.

Authority Authority If admitted as a member, I agree to be bound by the rules of the HRSA. See Terms and Conditions here.

Second Member Second Member If you wish add a second member please tick the box and enter your Membership number ( if applicable) and name of the member whose address you share here.

Second member name