*** Application for membership in SCRA ***
Sonoma County Radio Amateurs, Inc.
PO Box 116, Santa Rosa, CA 95402

(Please print this, fill it out, and send it in with your check.)

Name__________________________________ Callsign______________ License Class_____________

Address__________________________________ Phone_______________ Date_________________

City____________________________ Zip___________ New Application_____ Renewal_____

E-mail (if any)________________________________     Please Send Short Skip to my E-mail address  (  )YES!  (  )No thanks

SCRA Dues: The renewal date for SCRA dues is March 1st. Dues are $24/year for individual and $36/year for families.
The new member Name/Callsign Badge fee is $10/person. Dues for new members only are prorated quarterly, starting at the renewal time.

(Please make checks payable to SCRA.)

I WOULD LIKE MORE INFORMATION ABOUT:
( ) Public Service Events                  ( ) Acting as club Net Control Station
( ) ARES Emergency Services ( ) Helping with VEC license exams
( ) Taking a Novice or Technician class ( ) Field day, other operating events
( ) Teaching a Novice or Technician class ( ) Helping with Short Skip Newsletter
( ) Taking an upgrade class ( ) Other____________________________
( ) Teaching an upgrade class

SCRA Dues:
Individual $24, Family $36 +________
Name/Call Badge $10/person +________
SCRA Patch $5/ea                      +________
SCRA T-Shirt $10/ea Circle S M L XL   +________
Prorate discount -________ (Prorate discount is quarterly
$6.00/quarter for individuals,
and $9.00/quarter for
families figured from March 1st.)
Total: ________

Name Badge Information (new members)  Fill in exactly as you want 
it to appear on your badge.

Callsign____________________ First Name______________________ City____________________