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.