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                                                  ___   CQ CQ CQ Membership*
         (Subject to Trustees’ Approval)                                                                                                               * ( Limited Time Offer )
       

        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  )
           __ NEW CQ CQ CQ Member (All Dues waived - Membership Expires June 30, 2022 **
                      ** This is a Limited Time Offer, and will be withdrawn soon.

         __ 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 


 

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