MEMBERSHIP APPLICATION

(Please print)

Name:__________________________________________  Callsign: ___________

Birthday:  Month ___________  Day _____   Class of License: _________________

Address: ___________________________________________________________

City: ____________________________________________    ZIP: _____________

Telephone: ______________________   E-MAIL:  ___________________________

Spouse's Name and Birthday: ___________________________________________

Year your were first licensed: _______________________________

Are you currently active? _____________

Bands and modes: ___________________________________________________

Are you an ARRL member? ______________

If not, would you like to become a member? ______________

Are you a SLOECC member? _______________

If not, would you like to become a member? _______________

Estero Radio Club Inc. is a registered California 501(c)(3) Non-Profit Corporation.
Member dues are $15.00 per year and $26.00 for two family members.
Dues are payable on January 1 each year and delinquent on April 1.

Make out checks to: Estero Radio Club Inc.

Print this page and mail it with your check to:

Estero Radio Club Inc.
P.O. Box 6521
Los Osos, CA


You may also bring your check and application to the next meeting.