MEMBERSHIP APPLICATION

Amateur Radio Club of El Cajon, Inc.
Select Action:

1. What is your Amateur Call Sign:
2. What is your Class of License:

3. Last Name:
4. First Name:

5. Date you were first Licensed:
6. Old Previous Call Signs you have held:

7. Name you would like on your club Badge:
8. What date does your present License Expire?

9. Please give your address which we can send our newsletter
STREET:
CITY: State:
ZIP CODE(+4)
Country: 10. E-Mail Addresss

11. What is your Home Phone Number

May we publish your number in the membership roster?YESNO 12. Work Phone (Optional)

13. Date of Birth (Day Month)(year optional)
13. If you are married, what day is your Wedding Anniversary

15. Check here if you are a member of the ARRL. 16. Check here if you are a member of ARES.

17. Check here if you are a member of RACES. 18. Other Interests

19.a. Family Membership with: (Spouse)
Name: Callsign: (if any)
Birthdate (Day Month)(year optional)
19.b. Child 1
Name: Callsign
Birthday (Day Month)(year optional):<="20" TYPE="text" NAME="Child1_BDATE">

19.c. Child 2
Name: Callsign
Birthday (day Month)(Year Optional):
19.d. Child 3
Name: Callsign;
Birthday (Day Month)(Year Optional):

Send check made payable to: A.R.C.E.C., Inc. For renewal:$20.00 for a single or $25.00 for a family membership. New members: Please add $5.00 per person (member), initiation fee. Return to Amateur Radio Club of El Cajon, Inc. C/O: Membership Chair: David Cyr
P.O. Box 50, El Cajon, CA. 92022. Please note on the check the day this form was submitted Any questions, please call: (619) 328-0246
If you would wish, you can print out this form and send it to the address above.

Click here for a Member Application in .PDF format

Return to HOME Page
Updated 3/5/2005, Tom, KC6NXZ
Return to Table of Contents...

1. What is your Amateur Call Sign:	2. What is your Class of License:
3. Last Name:	4. First Name:
5. Date you were first Licensed:	6. Old Previous Call Signs you have held:
7. Name you would like on your club Badge:	8. What date does your present License Expire?
9. Please give your address which we can send our newsletter STREET: CITY: State: ZIP CODE(+4) Country:	10. E-Mail Addresss
11. What is your Home Phone Number May we publish your number in the membership roster?YESNO	12. Work Phone (Optional)
13. Date of Birth (Day Month)(year optional)	13. If you are married, what day is your Wedding Anniversary
15. Check here if you are a member of the ARRL.	16. Check here if you are a member of ARES.
17. Check here if you are a member of RACES.	18. Other Interests
19.a. Family Membership with: (Spouse) Name: Callsign: (if any) Birthdate (Day Month)(year optional)	19.b. Child 1 Name: Callsign Birthday (Day Month)(year optional):<="20" TYPE="text" NAME="Child1_BDATE">
19.c. Child 2 Name: Callsign Birthday (day Month)(Year Optional):	19.d. Child 3 Name: Callsign; Birthday (Day Month)(Year Optional):
Send check made payable to: A.R.C.E.C., Inc. For renewal:$20.00 for a single or $25.00 for a family membership. New members: Please add $5.00 per person (member), initiation fee. Return to Amateur Radio Club of El Cajon, Inc. C/O: Membership Chair: David Cyr P.O. Box 50, El Cajon, CA. 92022. Please note on the check the day this form was submitted Any questions, please call: (619) 328-0246 If you would wish, you can print out this form and send it to the address above.