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: ____________________________________
