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
CITY:  State:
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

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Updated  3/5/2005, Tom, KC6NXZ
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