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