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.