NCDXA - A club with heritage, experience and proven performance
in leading the way for DXers since 1972
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National Capitol DX Association's
Membership Application
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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.