Membership Application Form

Membership Application

To apply for membership please complete all questions.

AVAILABLE MEMBERSHIP OPTIONS

New member application fee:	$2.00
Full membership:	$18.00
Social membership:	$15.00
Associate membership:*	$15.00
Family membership:**	$10.00

New members joining after the first quarter will be charged dues pro-rated by quarter.

* An associate (unlicensed) member who receives his/her Amateur Radio license during his/her membership year will be awarded Full membership for the remainder of the year.

** The family membership fee covers all additional individuals of the family living in the same household as the regular member.

Membership Type
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New member application fee$2.00

Full Membership$18.00

Social Membership$15.00

Associate Membership$15.00

Family Membership (add to Full membership$10.00

Total $0.00
For Family Membership, list additional member names and callsigns if applicable
Name

First Name Last Name
Call Sign
License Class
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail
Home Number

Area Code Phone Number
Cellular Number

Area Code Phone Number
Work Number

Area Code Phone Number
Additional memberships with other groups, check all that apply:
Questions and/or comments about what interests you
Enter the message as it's shown*
Click "Apply for Membership". Your form will be sent to the club Treasurer who will make contact with you via email to complete the process. Thanks for your interest!
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