Please print, fill out and mail with your check payable to the DDXA, to:

        Your Call: _______________            License Class: ________________           

        Name: ________________  ______  ___________________________

        Address: _________________________________________________

        City: ________________________  State: ______  Zip: ____________

        Home Phone: (____) _____ - _____   

        Do you want your phone number listed on the Club Roster?   Y    N

        Birth Date: ____/____/____   E-mail: _____________________________

        Are you an A.R.R.L. Member?   Y     N      If yes, expiration date (___/___)

        Please list any family members that are also Hams.

        Name                                              Call                                License Class

        _____________________________________________________________

        _____________________________________________________________

        Dues are payable yearly on your membership anniversary date and are:

        $20.00 for Associate Members and $10.00 for Auxiliary Members.

        If you desire a Speed-Dial  number, ( you must be a licensed ham ), add $10.00.   

        A Speed-Dial number will be assigned to you 'ONLY' 

        ( if your phone number is a non-toll call from the city of Reading ).

        Signature: ______________________________  Date:____/____/____