This Online Application form may be used if you intend to pay your membership dues online via Zelle. After submitting your application, use your Zelle App to send Dues to WA9ORC@gmail.com.

After receipt of payment via Zelle and verification of application information, your membership will be entered into the CFMC Club Roster.

Please complete all fields.

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Name *

First

Last

Call Sign *

License Class *

• Technician
• General
• Extra
• None (Associate Member)

Applications accepted from persons that are not yet Licensed Ham Operators (No voting rights)

ARRL Member? *

• Yes
• No

Email *

Phone *

Address, City, State, Zip *

Please enter your Mailing Address

Do you want your Phone Number published in the Club Roster? *

• Yes
• No

Do you want your Email published in the Club Roster? *

• Yes
• No

Do you want to receive the Squelch Tale (Newsletter) via Email? *

• Yes
• No

Emergency Contact Name (Optional and Confidential)

Person to contact in the event of an Emergency – OPTIONAL and CONFIDENTIAL

Emergency Contact Method (Optional and Confidential)

Phone Number or Email Address of Emergency Contact – OPTIONAL and CONFIDENTIAL

Type of Membership *

• $30 – Full Member
• $20 – Student Member (under 18 yrs of age and full-time Student)
• $20 – Senior Member (over 65 yrs of age)
• $20 – Disabled Member

Payment Method *ZelleCash in-personCheck in-personCheck via Mail

How do you intend to submit Dues Payment?

Sponsor #1 Call Sign (New Members Only) *

Any of the CFMC Net Control Operators can be used as a Sponsor

Sponsor #2 Call Sign (New Members Only) *

Any of the CFMC Net Control Operators can be used as a Sponsor

Submit

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