Application For Membership
Navy-Marine Corps Military Affiliate Radio System

                        Assigned MARS Call Sign: NNNØ

                   Type of Application:  New Renewal Modify Transfer Delete

Personal              Name:

Information          Address:

                             City: State: Zip Code:

                            County: Date of birth: ( Must be 18)

                            U.S. Citizen? Yes No If No, are you a Resident Alien? Yes No

                            Home Phone: Work Phone: FAX:

                            DSN: E-Mail Address:
_______________________________________________________________________________________
Amateur                (Attach copy of your FCC Amateur License)
Radio                    Amateur Call Sign: Class: Expiration Date:
License                 Type of Station: Personal Military Club
Information           If Club Station enter Trustees Call Sign:
____________________________________________________________________________________________________
Internet                The only information that can be listed on a NAVMARCORMARS web page is your 
And                      MARS call sign, first name and state. For any other Personal Information (as listed
World-Wide          above) to be shown on a web site you must specifically authorize what information
Web                      may be placed on the web page. Please list the additional Personal Information you
Release                authorize to be listed and then sign and date beneath it.

                             Name Address City State Zip Code Home Phone Work Phone
                             Amateur Call License Class E-Mail Address

                             Signature:                                                         Date:
____________________________________________________________________________________________
Privacy                Privacy Act Statement: Under the authority of 5 U.S.C. 301 AND 10 U.S.C. 133, the
                            information requested on the Navy-Marine Corps MARS Application for Membership
                            is for the purpose of establishing, renewal or modification of MARS membership.
 Act                     The form  will be maintained as official Navy-Marine Corps MARS records. The
                           information on this form will not be divulged to non-MARS members without your
                           written consent. Disclosure of the information requested on this form is voluntary.
 Release             Failure to provide this requested information may result in disapproval of the
                          application or inordinate delays resulting from additional research required to establish
                          satisfactory eligibility.

                          Signature:                                                                              Date:
_____________________________________________________________________________________________
NMC Form 2093/1