Membership Form

NORTH ALABAMA DX CLUB

PRESIDENT
Mark Brown, N4BCD

VICE PRESIDENT 

Jim Spikes, N4KG 

APPLICATION FOR MEMBERSHIP

 

The NADXC encourages all club members maintain current membership in the ARRL.

ARRL Member YES _________ NO _________

NAME _____________________________________ CALL _________________________________

SPOUSE’S NAME ___________________________ LICENSE CLASS _______________________

STREET ADDRESS __________________________________________________

CITY ______________________________________ STATE ___________ ZIP _________________

PHONE (HOME) _____________________________ (WORK) ______________________________

EMAIL ADDRESS __________________________________________________________________

NO. OF YEARS LICENSED _________ OTHER CALLS HELD ______________________________

NO. OF YEARS AS AN ACTIVE DXER ___________ HONOR ROLL MEMBER ________________

DXCC COUNTRIES CONFIRMED TOTALS: MIXED __________ SSB __________ CW __________

OTHER RADIO CLUB AFFILIATIONS ___________________________________________________

FAVORITE DX ACTIVITY (i.e. LOW BAND DXING, CW, ETC.) _______________________________

WILL YOU BE ACTIVE ON:

2-MTR DX ALERT REPEATER? ____________________________

 

 

 

 

Please return your application to:

 

Kelley Johns W4VPZ
treasurer@nadxc.org

NADXC Secretary/Treasurer

3117 Wildwood Drive            Huntsville, AL 35801