SCCARA
	
	Santa Clara County Amateur Radio Association
	PO Box 106
	SAN JOSE , CA  95103-0106

		SCCARA  Membership  Form  for  2012

           (Fill in name and call only if renewing and no info has changed)

Name:________________________________ Call:_______________ Class: E  A  G  T+  T  N 
 
Licensed since (yr):______________ License Expiration Date (mo/yr):_______________                                 

Address: __________________________________________________________________________ 

City: ________________________________________ State:_________ Zip:__________-______         

Telephone: (________) _______-____________________  ( ) New Member   ( ) Renewal                     								                                                ( )I'm also a member of the ARRL

E-mail: _____________________________________________________________________
        (your e-mail address must be legible and correct
         if you want the newsletter by internet)

Memberships begin January 1 and expire December 31.
If renewing:  annual membership dues (base rate) are: $20 Individual, $25 Family, $10 Student (under 18)

For new members:
   If joining in January:  base rate
   If joining in February through October: base rate x (11 - month) x 10% e.g. for June, that would be: base rate x 50%)
   If joining in November or December:
 free for November and December if paying the base rate for the following year

$ ___________  Dues payment for:     __  individual       __ family       __ student

For family memberships (at the same address), please include a separate form for each family member.

I want the newsletter by: __ U.S. Mail  __ internet  (saves the club a lot of money)

Give this completed form (or copy) with payment to the Secretary or Treasurer at any meeting or mail to the club address.                              rev. 12/15/10