Membership Application
This form is intended to collect information for only 1 member

Application Date

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

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.