Membership Application

Be good to your friends: invite them to be CCRA members

Capital City Repeater Association

"Serving the Capital City in a Capital Way"

Name:

Email:

Call:

Street Address:

City: State:

ZIP+4: -

Home telephone number: ( ) - May we list your number on the roster?

ARRL member?

Check the type of membership:

1 year associate for those outside central Ohio ($13.50)

1 year full ($25.00)

2 year full ($50.00)

3 year full ($75.00)

Yes! I want to help. My donation of $ is enclosed to help the CCRA system grow.

A CCRA membership covers all family members that are licensed and live with you. List their names, call signs, and email addresses:

Name:

Email:

Call:

Name:

Email:

Call:

Name:

Email:

Call:

At the present time you will need to print this form and mail it with your check.

Be sure to place your call sign on all checks and correspondence and mail to:

CCRA
913 Middlebury Dr N
Worthington, OH 43085-3372

To become a member please print this form with the print feature on your browser and mail to the address above.

Thanks.

CCRA