Day:
Month:
Year:

Name

First: 
Last:

Callsign
(main callsign only)

Address

Address:
City:
Postal Code:

Personal Contact Information

Home Phone:
Mobile:
E-mail:
Please include me in club e-mail updates:
Yes
No

Note:From time to time our members receive club news, meeting reminders and other important updates via e-mail. However, if you would not like to receive such e-mails, please be sure check the box.

Membership Fee (Due In September)

Membership Rates
Single Membership $50 Family Membership (Minimum of 2) $35/ea

Note: If you are submitting for a family, We kindly ask that you complete a form for each family membership. You will find a link on the next page, to return to this form.