Club Membership Registration Form

CQC Membership Application

Complete the form below to sign up and become a member.
(Membership is FREE but we'd appreciate you submitting this application form even if you're not purchasing anything. We do accept donations through Zelle using coloradoqrpclub@gmail.com we are not tax deductible).
Name*

First NameLast Name
Callsign*
E-mail*
example@example.com
Phone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please ensure that your contact info is always current with us.
- We do not give out your personal inforomation without your permission!)
Additional family members: Please list each of their names and callsigns here:

NameCallsign
The following information is optional, but would be of interest if you provided it:
ARRL Member?

YESNO
Your Web Page URL:
License Class:

ExtraAdvancedGeneralTechnicianTechnician PlusNoviceForeignNone
Other QRP Club Memberships:
Occupation:
Are you...

Active in QRP?Inactive?New to QRP?Interested in QRP?
If Active on what bands?
QRP Interests:

OperatingTechnicalDXContestsConstructionPortableMobileVHF/UHFQRPpDigitalAntennas
Other QRP Interests:
QRP Equipment you own/use:
Privacy Notice

The Colorado QRP Club recognizes that privacy is very important to our members, and we pledge to protect the security and privacy of any personal information members provide to us.
Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!
Should be Empty:

CQC Membership Application