Clinton County Amateur Radio Association Membership Application www.ccara.net <Clinton County Amateur Radio Club, Inc Home Page Please print this page and mail application to: CCARA Treasurer PO Box 222 Martinville, OH 45146-0222

The Clinton County Amateur Radio Assn. (CCARA) welcomes you to join our club. The dues are only $10 per year and $5 per additional family member.

Please complete the application below then give it to a club member, bring it to a meeting or mail it to the address listed above.

Name: __________________________ Call Sign: _____________

Address: _______________________________________ ______________________________________________

City: ________________________________ State:_____________ Zip: ____________

Phone Number: (____)___________ Email Address (Optional): ______________________

Birth Date (Optional): ___________ License Class: _________ ARRL Member? Yes No

Annual Membership Fee: $10

Number of additional family members joining (if applicable): _____ x $5 = $_____

Total Enclosed: $_________

Please make checks payable to: CCARA