Membership

Application for Membership

Complete the form below to apply to the Leon County Ham Radio Club. When you submit, we'll generate a PDF application and deliver it to club leadership.

Leon County HAM Radio Club

Application For Membership

Applicant Information

First Name

Last Name

Call

Class

License Date

Expiration Date

Sex

Age

Birthday — Month

Birthday — Day

Contact Information

Address

City

State

Zip

Phone

Cell

Email Address

Spouse Information (if applicable)

Spouse's Name

Call

Class

License Date

Expiration Date

Sex

Age

Birthday — Month

Birthday — Day

Other Hobbies

Would you serve in the capacity of:

Committee Member

Club Officer

Volunteer Examiner

Instructor

Other Information

indicates a required field.