|
Coal
Fields Amateur Radio Association
Membership Application
Club
dues are $10.00 per individual and make
checks payable to CFARA and mail to:
CFARA
11 North Evergreen Lane
Lancer
Kentucky
41653
YOUR FULL NAME :
_____________________________________________
CALL SIGN:|___|___|___|___|___|___|
LICENSE CLASS: TEC [__] GEN [__]
ADV [__] EXA [__]
MAILING ADDRESS :
____________________________________________
PHYSICAL ADDRESS :
___________________________________________
CITY :
_______________________________________________________
COUNTY :
_____________________________________________________
STATE : Kentucky [__]
________________________________________
[If you are in Kentucky,
just check it]
ZIP CODE :
___________________________________________________
PHONE NUMBER(s) :
____________________________________________
E-MAIL ADDRESS :
_____________________________________________
BIRTHDAY : (Optional): (MM/DD/YYYY)
[____/____/_______]
ARRL MEMBER : Yes [__] No
[__] Wanna be? YES I would [__]
|