NCARC Membership Application




             The North Coast Amateur Radio Club                                             ___  This is a change of 
        P.O. Box 30529 Cleveland, Ohio 4 4130-0529                                      information (or NEW)
                                                                                                                              ___  This is a renewal, 
        APPLICATION / RENEWAL - NCARC MEMBERSHIP                         use the same info
         (Subject to Trustees’ Approval)                                                       ___   Renew family members
        DATE: ____________________, 201__
        CALL SIGN: _____________________
             CLASS:    Nov  -  Tech  -  Plus  -  Gen  -  Adv  -  Ex  -  None     EXPIRES?:  ___________
                                  (circle one)
        LAST NAME : __________________________________________________________________
       FIRST NAME ( for roster ) :  _______________________________  MIDDLE INITIAL : ________
       ADDRESS _____________________________________________________________________
       CITY:  _____________________________________________    COUNTY:  _________________
      STATE :  ____________________________________                ZIP: ____________ - __________
      PHONE:   ( ______ )   _____ - ________________  UNLISTED?: Y / N,  MAY WE PUBLISH?: Y / N                                                                                                                    (circle one)    (circle one)
        E - MAIL ADDRESS:  _____________________________________________________________
             Do you wish to receive the newsletter at your E - Mail address?   Y  /  N   ( circle one )

       ARRL MEMBER?   Y  /  N                ARRL MEMBERSHIP EXPIRES: ___________________
                               ( circle one )
        TYPE OF MEMBERSHIP REQUESTED:   (  check one  )
         __ INDIVIDUAL MEMBERSHIP -- $20.00 annual dues (July 1 thru June 30)
                    **NEW** members (first-time) may prorate their dues:
                                 July/$20.00,   August/$18.50,   September/$17.00,   October/$15.00,
                                 November/$13.50,   December/$12.00,   January/$10.00,   February/$8.50,
                                 March/$7.00,   April/$25.00 *,   May/$23.50 *,   June/$22.00 *
                                  * means new members will be valid until June 30 of following year.

          __ SENIOR (over 64) / JUNIOR (under 18) MEMBERSHIP -- $12.00

          __ FAMILY MEMBERS - $2 per year. Family member must reside at same address
                as an individual member and may not be prorated.    CALL _______    Name  _______________
               Any Questions?    Mary Lou, K8MLS  ( 216 )  509 - 6933  or  E - Mail:   k8mls@wowway.com