NCARC MEM APP

Nevada County Amateur Radio Club

Membership/Renewal Application

Todays Date:

Required

Type of Application

NEW Membership Membership Renewal Change Roster Information Badge Order ONLY

Required

NEW Membership: This is for an Amateur who is applying for first time for a NCARC membership. This is the ONLY membership that may be prorated!

Membership Renewal: This is for an Amateur who had previously been a member and is now renewing.

Updating Roster Information: Updating your info. due to a Name, Address, License or Class statis change.

Badge Order ONLY: A Member may order a club name badge ONLY.

First Name:

Required

Last Name:

Required

Select Your Date of Birth:

Required
mm-dd-yy or mm-dd-yyyy

Mailing Address:

Required

City:

Required

Select State

Required

Zip Code:

Required

Cell Phone Number:

Required
530-234-1234 Enter without separators: 5302341234

Email:

Required

Confirm

Type of Membership:

NEW Mem Q1 $20 NEW Mem Q2 $15 NEW Mem Q3 $10 NEW Mem Q4 Now to next Q4 $20 Individual Membership $20 Family Membership $26 Non-Licensed Assoc. $6

Required

Class of Licence:

Required

Ham Call Sign:

Required

Do you hold a GMRS License?

YES NO

Required

GMRS Call Sign:

Club Name Badge

Although the wearing of the official club name badge during meetings are optional, it is highly recomened. When you wear the official club name badge, it will make it easy for someone that you may have only spoken to on the air to spot you from acrosse the room. When taking part in a club sponcered event, it is required!

Order a Club Badge? $20

YES NO

Required

Name to be on Badge

Required. Your Frist Name or Nick Name.

NET ROLLCALL

The club weekly net is a great way to stay in touch and on top of all club announcements and events. Rollcall is for MEMBERS ONLY. We encourage all club members to request to be called during rollcall. If you miss five (5) consecutive nets, your name will be stricken from the rollcall until you requested to be reinstated.

Net Rollcall

YES NO

Required.

Are You A Member of:

Are you a member of any other Amateur Radio club or Organization?

YES NO

Required

Please list all that might apply.

Add Family Members

First Name:

Required

Date of Birth:

Required

Class of Licence:

Required

Call Sign:

Required

Would you like to order a club Badge? $20

YES NO

Required

Name to be on Badge:

Email

Required

Confirm

Add Another Family Member

NO YES

First Name:

Required

Date of Birth:

Required

Class of Licence:

Required

Call Sign:

Required

Order a Badge? $20

YES NO

Required

Name to be on Badge:

Email

Required

Confirm

Add Another Family Member

NO YES

PRIVACY NOTICE: Your information will not be sold or otherwise released to the public. Your information will be used by the club for club businnes. For the purpose of contacting you, your Call Sign, name, e-mail address, phone number and address may also be released to ONLY club members!

Agree?

Yes No

Required

Please Print this form first, then Select SUBMIT when finshed!

TOTAL AMOUNT is on the Next Screen. See payment method below.

Payment:
Send Check to:
NCARC
PO Box 2923
Grass Valley, CA 95945
OR
Pay in person at next club meeting. Meetings are held on the second Monday of each month at the Salvation Army Community Center behind the church at 10725 Alta St in Grass Valley. You’re not a member until payment is recieved.