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*** 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, $36/year for families, and $18/year for youth (under 18). The new member Name/Callsign Badge fee is $10/person.

(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,
Youth (Under 18) $18                  +________

Name/Call Badge   $10/person
Circle   Magnet  Clip                 +________
SCRA Patch $5/ea                      +________
SCRA T-Shirt $10/ea                   +________                            

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

  Callsign____________________  First Name______________________  City____________________