Clone of SFDXA Application Form

South Florida DX Association

Online Membership Application Form
Name of Applicant:*

First NameLast Name
Call Sign(s):*
License Class:*
Address of Applicant:*

Street Address

Street Address 2

CityState / Province

Postal / Zip CodeCountry
Home Phone:

Area CodePhone Number
Work/Cellphone:

Area CodePhone Number
E-mail of Applicant:*
Referred by (if applicable):
ARRL Member?*
We encourage ARRL Memebership
2 Meter FM Capable?*
DXCC5BDXCCWAZWASWACQCWAFOCFred Fish
Other Awards Earned:
16080604030201715121062432
SSBCWDigital- otherDigital FT8/FTx
ContestsDX'ingRag ChewingSatelliteAPRST HuntsGoing on DXpeditionsDMRGPRS
Em CommTraffic HandlingNetsARES MemeberField DayRACESMARS
Station Equipment:
Antennas, Type & Band Capability:
Radios
Amplifier(s):
Enter the message as it's shown*
The South Florida DX Association is a "NOT FOR PROFIT" Florida corporation, affiliated with the ARRL.

Full Membership requires attending a club meeting and a club member sponsor.
Should be Empty:

South Florida DX Association