Application Form

This application form can be printed from this page. Just go to File, Print. Fill out this application and mail it with your check to the address below or bring it to the next meeting. You can become a member the same night! All applications are reviewed by the membership committee and voted on before the program.

Name: ______________________________________

Address: _____________________________________

City: ___________________________ State: ______ Zip: ____________

Phone (Residence): __________________ Phone (Work):_________________

Date of Birth: ________________________

Call Sign: ______________________ Class of License: ________________________

Date License First Issued: __________________________

ARRL Member? Yes ____ No ____

Occupation: ______________________________________________________________________

Sponsoring Member (if any): __________________________________________________________

Other Hobbies or Interests: ___________________________________________________________

Comments: What are your preferred Ham activities? What types of programs would you like to see at Club Meetings?

________________________________________________________________________________

________________________________________________________________________________

Send your application to:
Cherokee County Amateur Radio Club
P.O. Box 736
Centre, Alabama 35960

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You can reach Our Club by e-mail at:

w4cca@powernet.org

Copyright © 1998 W4CCA

Created January 17, 1998

Most recent revision December 6, 2000

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