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Clinton County Amateur Radio Club Membership Application
- 2005
Please print this page. Fill in all the information on the form
and return it with the appropriate dues in person or mail it to
the address above.
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Name:
| Call:
| License Class:
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Address:
| Status:
| Phone #:
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City:
| State:
| Zip:
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Email:
| Date of Birth:
| Year Licensed:
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| Other Memberships |
| ARRL | ARES | MARS | RACES | QCWA | 10-X |
Any other ham radio-related organizations, now or in the
past?
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Ham radio interests (i.e. Emergency communciations,
net operator, digital mode operation, etc.)
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| Membership Payment due: |
| Single ($15.00) |
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| Life ($300.00) |
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| Additional donation: |
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| Total Enclosed: | |
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1 - Payment made after August 31st applies to the membership for the following year
2 - CCARC Life Membership is available for 20 times the current Single Membership
rate. Family memberships are paid annually.
3 - Please indicate your membership Status in the space provided
as: New, Renewal, Life Member, Update (for mailings) etc.... |
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