CALGARY COMMUNICATIONS CLUB      UP

New Application____ Renewal ____ Information Changes ____

Name of Member_________________________________Call Sign___________
(Please Print Name above Line)

Address____________________________________________________________

City_____________________ Province__________ Post Code____________

Phones: HOME__________________ WORK________________

E-MAIL ADDRESS_____________________________________________________

Year First Licensed _______    Class of License________________________________

SCHEDULE OF FEES

FULL MEMBER.................................. $ 15.00 Per Year
FAMILY VOTING MEMBER............. $ 5.00 Per Year
NON VOTING ASSOCIATE.............. $ 15.00 Per Year
NON VOTING FAMILY..................... $ 5.00 Per Year
CLUB NAME BADGE WITH CALLSIGN..........$ 8.00
DONATIONS...For More Fun.............. $ __.__

TOTAL FEES ATTACHED $ ______

MEMBERSHIP FEES RENEWABLE SEPTEMBER 1st of each year.

CHEQUES or MONEY ORDERS PAYABLE TO:
CALGARY COMMUNICATIONS CLUB
C/O 3112-39 St. SE
Calgary, Alta. T2B 1B1

Receipts issued at Sunridge Mall Coffee on Saturday mornings or at General Meetings to save postage expenses.
__________________________________________________________________
Do Not Mark below this line For OFFICE USE ONLY

CHEQUE_____ MONEY ORDER _____ CASH _____ AMOUNT $_____.____

Receipt Number Issued 20-_____