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Membership Application
Canadian Ladies Amateur Radio Association

 

 

         Canadian Ladies Amateur Radio Association

Application for Membership

 

Please check here:        New                 Renewal

 

 

Name: ________________________________________________________________________

 

Callsign(s): ____________________________________________________________________

 

Address: ______________________________________________________________________

 

Country: _____________________________    Postal Code (Zip): ________________________

 

Telephone: ___________________________    E-Mail: ________________________________

 

Birthday: (No Year Required) Day: _________  Month: _______________   Year: ___________

 

Year of first Amateur license & current qualifications: __________________________________

Basic:               Advanced:                  CW:             wpm: __________   Other: _________

 

Additional hobbies other than ham radio: ____________________________________________

______________________________________________________________________________

 

Sponsors Name and Callsign, if you are sponsored into CLARA: ________________________

______________________________________________________________________________

 

Names and call signs of family hams and your relationship: _____________________________

______________________________________________________________________________

 

 

 

Annual Dues: (to be paid by January 1st of each year)

 

  • Canadian YL Full Membership - $12.00
  • Additional Family Member YL (same address) - $3.00
  • US Associate YL - $14.00 (Canadian)
  • DX YL - $16.00 (Canadian) (airmail)

 

Please mail this completed form with appropriate payment (cheques payable to CLARA) to:

Heather Holmes VE3HQH

Treasurer, CLARA - 2600 Boag Road, R.R. #1, Queensville, Ontario Canada L0G 1R0

Email: ve3hqh@rac.ca

 

 

 

 

 

Treasurer Use Only:

 

Received: ___________________________________     Processed: ___________________________________

 

Treasurer: ___________________________________     Secretary: ____________________________________

 

 

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