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N5MAD
MINDEN AMATEUR D-STAR
“We are M.A.D.”
MEMBERSHIP APPLICATION
Applicant Information:
NAME:______________________________________________________________
MAILING ADDRESS:__________________________________+_______________
CITY:_______________________________STATE_______ZIP CODE___________TELEPHONE: (HOME)_________________(BUSINESS OR CELL):_______________
CALL SIGN:________________ E-MAIL:_________________________________
FEE INFORMATION Enclosed
Annual Dues (January-December):-----------------------$20.00 per year......$_______
Additional Donation(optional, but very helpful to the club..........................$_______
TOTAL ENCLOSED..............................................................................................$_______
Acknowledgment Information
I hereby make application for Associate Membership in Minden Amateur D-Star. I
understand the privileges and opportunities provided by the organization, and agree to
support the club in its efforts.
__________________________
SIGNATURE |
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