McHenry County Wireless Association
Membership Application
Date: _________________
First Name: _____________________
Last Name: ______________________________
Address: ________________________________
City: ________________________ State: _____ Zip: ______________
Home Telephone: _________________________
Work Telephone: _________________________
E-Mail Address: ____________________________
Current Callsign: _________________ Previous Callsign: _______________
License Class: __________________
Expiration of License: _____________
Expiration of MCWA Membership: _______________
ARRL Member: Yes No
Other Hams in the Family: ______________________ Call: ______________
Other Hams in the Family: ______________________ Call: ______________
Other Hams in the Family: ______________________ Call: ______________
New: Renewal :
Fee: $15 per family
Print this application and mail to:
John Dewey, KA9CAR
37 Faringdon Dr.
Crystal Lake, IL 60014

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last update 01/21/2000 by kfarver@mc.net