SFDXA PROSPECTIVE MEMBER INFORMATION

 

 

 

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MEMBERSHIP APPLICATION

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CALL ________________CLASS_________ YEAR FIRST LICENSED ________

NAME_____________________________________ Spouse ________________

ADDRESS_________________________________________________________

CITY___________________________________, STATE______. ZIP__________

CONTACT INFORMATION:

HOME PHONE___________________  CELL/WORK PH ________________(optional)  ;  E-MAIL _____________________________

OTHER INFO:    ARRL MEMBER?___YES____NO (membership is required)

AWARDS EARNED: DXCC ______; 5BDXCC ______; WAZ ______: WAS _____; WAC _____; QCWA _____;
FOC ______ ; OTHERS ______________

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OPERATING INTERESTS:
HF BANDS: 160___. 80 ___, 60 ___, 40 ___, 20 ___, 17 ___, 15 ___, 12 ___, 10 ___, 6 ___.  VHF/UHF ____   
MODES: CW ___, SSB ____, RTTY ____;  
ACTIVITIES:   CONTESTING ____    DX ing____   DIGITAL ___, PSK ____  Satellite ___    APRS ___   'T' Hunts ____  Other ___________________

Service Interests: Emergency Communications ____ ;   Public Service  Events____ ; Traffic Handling _____;  Field Day ____

Station Equipment:
Antennas:  Type ________; Bands _________ | -Type________;  Bands _________ | - Type ________;  Bands ________
Receivers A:    HF _________________;    VHF _______;    UHF ______  : Other:  SSTV _____  ; 1-1/4 M (220mHz) _____
Receivers B:    HF _________________ 
Amplifiers:  _________________, _________________

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The South Florida DX Association is a "NOT FOR PROFIT" Florida corporation, affiliated with the ARRL. 
Print form and Submit to Membership Chairman -
MARK HOROWITZ -K2AU
6831 SW 16TH ST
PLANTATION, FL 33317

Membership requires attending a club meeting and a club member sponsor. Sponsored by ____________________________________

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