CCAFMA APPLICATION FOR MEMBERSHIP             
                                                             *Memberships subject to approval.

DATE ________NAME_________________________CALL SIGN_________ ARRL MEMBER? Y/N ____
ADDRESS_________________________________________________________________________
CITY_____________________________STATE______ ZIP CODE____________COUNTRY__________
PHONE NUMBER: _____________________ DATE OF BIRTH (MONTH & DAY)__________________

E-MAIL ADDRESS ______________________________________________

MEMBERSHIP (check one) CHECK WITH TREASURER, $5 DISCOUNT MAY APPLY.....
REGULAR $25 ___ FAMILY* $30 ___SUSTAINING $35 & UP____
ASSOCIATE** $15_____ STUDENT*** (free) ____ NEW HAM (first year free)______
ACTIVE MILITARY (Free) ______ BRANCH OF SERVICE _____________________________

* Related/Unrelated persons living in the same household
** Principal residence 30 miles or more from Jamestown, non-voting member
*** May be asked to prove full time status
Make check payable to: CCAFMA
Mail to: CCAFMA, Box 81, Jamestown, NY 14702, bring to meeting or email to tjoneson@gmail.com
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Updated 5/2012