The North Coast Amateur Radio Club                                                                                    ___  This is a change of 
        c/o Dan Sarama, NCARC Treasurer                                                                                                    information (or NEW)
         4103 Keswick Dr.                                                                                                                                ___  This is a renewal, 
       Brunswick, OH 44212-7004                                                                                                                   use the same info
                                                                                                                                                                                ___   Renew family members
        APPLICATION / RENEWAL - NCARC MEMBERSHIP                                               
   
       

        DATE: ____________________,  202___                                                  

        CALL SIGN: _____________________                                       
        CLASS:    (circle one)   Nov  -  Tech  -  Plus  -  Gen  -  Adv  -  Ex  -  None    EXPIRES:  ________________


       FIRST NAME:  _________________________  MID INITIAL: ____  LAST NAME: _________________________________
       Preferred First Name for the Website MINI Roster: ______________

       ADDRESS: _____________________________________________________________________

       CITY:  _____________________________________________    COUNTY:  _________________

      STATE:  ____________________________________                ZIP: ____________ - __________


      PHONE:   HOME:   (         )  - ________________    UNLISTED?: Y / N,     MAY WE PUBLISH?: Y / N
      PHONE:   CELL:      (         )  - ________________     UNLISTED?: Y / N,     MAY WE PUBLISH?: Y / N                                    

      Email ADDRESS:  _____________________________________________________________
                                           Do you authorize the Club to correspond to you via Email?   Y  /  N  


       ARRL MEMBER?   Y  /  N                ARRL MEMBERSHIP EXPIRES: ___________________
    
        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@yahoo.com     
  ..


 

NCARC Membership Application - - Click PRINT to access this as a PDF Document

NOTE:  The N.C.A.R.C. Membership Year IS NOT A CALENDAR YEAR 
A Membership Year is from JULY 1st thru JUNE 30th.
  If you haven't Renewed as of yet, PLEASE DO SO as the Clubs Roster will be updated soon.  

  Be sure to use the address for our Treasurer Dan - KB8A
  shown on the Application above.