National Capitol DX Association (NCDXA)

NCDXA - A club with heritage, experience and proven performance
in leading the way for DXers since 1972

National Capitol DX Association's

Membership Application

A - Type of Member(Select one)

Full Member (1 year) (Dues: $30)
Full Member (3 years) (Dues: $85)
Associate (Dues: $15)

B - General Information ( Bold Fields are required)

Applicant Name:
Street Address:
City:		State/Province:
Zip/Postal Code:		Country:
Ham Call Sign:
Home Phone #:		Work Phone:
Cell Phone #:		E-mail:

C - Sponsor Information

Sponsor Callsign:

D - Membership Requirements (Full Members Only)

Do you have 100 DXCC Entities Confirmed?

Are you a current ARRL Member?

E - Applicant Signature : Type your name below (*)

Applicant Signature:

Date:

(*) I will comply with standard NCDXA Membership requirements.