Registration Page

Northern Colorado Amateur Radio Club
Information/Application Form

____ I would like more information on Amateur Radio.
____ I want to join the NCARC. My payment is enclosed.
____ I want to renew my membership. My payment is enclosed.

Annual Dues:
Family Membership: $25.00
Full Time Students: $5.00

Please fill in the following information.  If you are renewing please fill in your Name and call unless other information has changed. Any items left blank will be assumed to be correct in the NCARC database.

Name: __________________________________
Callsign: ______________________________
Street: ________________________________
City: __________________________________
State: _________________________________
Zip: ___________________________________
Telephone: _____________________________
License Class: _________________________
E-mail Address: ________________________

Please Select the following:

Receive Newsletter by E-mail? YES NO

Student? YES NO

ARRL Member? YES NO

Please mail this form to:

NCARC
P.O. Box 272956
Fort Collins, CO 80527-2956