City:________________________ State:_______ Zip:____________

Phone:( _____)________________ Birthdate:___________________

License Class:_____Expiration Date:_________ ARRL Member:____

Signature: ______________________________ Date:____________


E-Mail address: ____________________________________________

***Do not complete this section- for Membership Chairman only.***

Amount $_______Check #________ Taken By:_____ Date:________

LCARA membership is annual (Jan. 1 to Dec. 31) only. $10 per year, pro-rated at $2.50 per quarter remaining in the calendar year for new members. Additional family members at same address, $3.00 flat rate for new or renewals. Associates non-prorated $7.50/year
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Print out the application below and mail with appropriate dues to:

Jim Grimes KD8OCW
2929 West River Road N
Elyria, Ohio 44035
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