Use your browser's print command to print this page to use as a membership application/renewal form.
| Call sign | Name | Date |
| _________ | ___________________________________ | ____________ |
| Internet E-Mail Address: ____________________________ |
| | Show E-Mail Address on Club Website Roster? [_]Yes [_]No |
Street: _________________________________________ |
| City/State/Zip: ___________________________________ |
| Home Telephone No: ____________ | Work Telephone No: ________________ |
Newsletter Delivery (pick one):
| | [_] Printed copy |
| | [_] E-mail notification of links to web and Acrobat (pdf) versions |
Dues: $5.00 domestic, $8.00 Canada/Mexico, $10.00 elsewhere. Make check payable to SCCC.
[_] Check here and include an additional $6.00 if you would like a club badge.
Mail complete form to: Bruce Horn, WA7BNM, 4225 Farmdale Avenue, Studio City, CA 91604.
