Name__________________________________Address_________________________________________________________________________

City________________________________State_______ZIP____________Call Sign_______________

Phone________________________E-mail_________________________________________________

Dues for CTR membership are $12/year. This application is for ______ year(s) x $12/year = $________

The CTR club is affiliated with the ARRL. If an ARRL member, please indicate the ARRL expiration date as found on the second line of the mailing label of your QST magazine_______________________

Current amateur license (Novice, Technician, Tech plus, General, Advanced, Extra_________________

Bands / modes used____________________________________________________________________ (160m, 80m, 40m, 20m, 10m, 6m, 2m, 70 cm, AM, SSB, FM, SW, RTTY, SSTV, PSK, etc)

Radio Equipment_____________________________________________________________________

____________________________________________________________________________________________________________

Antennas_____________________________________________________________________________________________________

Indicate any areas in which you need some assistance from an "elmer" (a more experienced ham radio operator who is willing to volunteer his help________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

Information about the CTR club is available on the website www.qsl.net/w7nat.

Copy this form and send a check for dues, along with this completed form to the following address:

CTR Club
c/o Nathan Toews W7NAT
P.O. Box 4162
Salem, OR 97302