Application for Membership
Please print out this form, complete and sign, and send with payment to:
Joanna Dilley, K6YL; PO Box 399; San Carlos, CA 94070Name used on the air:
Call Sign:
Full Name:
(First) (Initial) (Last)Address:
City, State, Zip:
Area Code, Telephone: /
(OK to publish in Club Roster? ___Y ___N)E-Mail Address:
(OK to publish in Club Roster and Web Site? ___Y ___N)Member ARRL? ____ License Class ____ Years Licensed ____ Full-Time Student? ____
Other call signs held, past and present_______________________________________
I hereby apply for membership in the NCCC and certify that I am qualified for the membership class indicated. I agree to abide by the By-Laws of the NCCC and to notify the Secretary-Treasurer of any change in my membership status.
Signature:
Date:
Nominated By:
Name: Call: Date:
Name: Call: Date:
Name: Call: Date:
Brief description of station:
Operating preferences: CW _________% Phone __________
% RTTY ___________% Other _________% (mode?)
Contest experience and awards:
Favorite Contests:
Other comments:
Do you wish to order an NCCC badge (cost $20)? ____Y ____N
Name _______________________ and Call Sign ______________ to appear on badge.
NCCC Dues Schedule (Voluntary)
Recommended Fees
Member Class Date Joined or Renewed Dues Member Class Date Joined or Renewed Dues Full Member Jul 1 to Sept 30 $24.00 Family, Student, Associate Jul 1 to Sept 30 $12.00 Full Member Oct 1 to Dec 31 $18.00 Family, Student, Associate Oct 1 to Dec 31 $9.00 Full Member Jan 1 to Mar 31 $12.00 Family, Student, Associate Jan 1 to Mar 31 $6.00 Full Member Apr 1 to June 30 $6.00 Family, Student, Associate Apr 1 to June 30 $3.00 Note that while dues are voluntary, payment of at least the amount shown in the table above is necessary to receive personal club awards.
Amount Paid: Date:
Back to Membership ] [ Home ]
