(Please print)

Name: _________________________________________  Callsign: ___________

Class of License: _________________

Address: ___________________________________________________________

City: ____________________________________________    ZIP: _____________

Telephone: ______________________   E-MAIL:  ___________________________

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? ______________

For family memberships:

Family member name: ___________________________  Callsign: ___________

Class of License: _________________   E-MAIL:  _________________________

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  93412

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