CKARC Membership Application

NAME: _______________________________________________________________

CALL SIGN:_________________________ or Not Licensed __________

ADDRESS: ____________________________________________________________

______________________________________________________________________

______________________________________________________________________

EMAIL: __________________________________________

Phone: ___________________________________________

• ___ Single RAC member $20.00 (RAC# ___________________ )
• ___ Single Non-RAC member $30

Please make cheque out to: Chatham-Kent Amateur Radio Club

Mail to:
CKARC
P.O. Box 284
Chatham, ON
N7M 5K4

Or submit your membership form at a club meeting!