LACC Membership Form

First Name:_______________

Last Name:_______________

Callsign:_______________

Website:_______________

Email: _______________

Address Line 1:_______________

Address Line 2:_______________

City:_______________ State:_______________ Zip:_______________

What are you paying for?

Dues: $12.00 __  Patch $3.50 __  Donation $____.___

Total:$____.___

Signature:_______________  Date: ___/___/___

***Dues include 1 year membership for the Lubbock Amateur Contest Club and one LACC Patch.***

Mail to:

Josh Herring KC5VKA
2806 55th
Lubbock, TX 79413