Clone of SFDXA Application Form

South Florida DX Association

Online Membership Application Form
Name of Applicant (You do not have to live locally to become a member):*

First NameLast Name
Call Sign(s):*
License Class:*
Address of Applicant: (You do not have to live locally to become a member)*

Street Address

Street Address 2

CityState / Province

Postal / Zip CodeCountry
Home Phone:

Area CodePhone Number
Work/Cellphone:

Area CodePhone Number
E-mail of Applicant:*
How did you hear about us?
ARRL Member?*
We encourage ARRL Memebership
2 Meter FM Capable?*
How many DX Entities do you have confirmed?
Awards Earned

DXCC5BDXCCWAZWASWACQCWAFOCFred Fish
Other Awards Earned:
Operating Bands

16080604030201715121062432
Modes

SSBCWDigital- otherDigital FT8/FTx
Activities

ContestsDX'ingRag ChewingSatelliteAPRST HuntsGoing on DXpeditionsDMRGPRS
Service Interests

Em CommTraffic HandlingNetsARES MemberField DayRACESMARS
Antennas, Type & Band Capability:
Radios
Amplifier(s):
Are you antenna-challenged? (describe)
Would you like to be mentored so that you could possibly use our club station at Florida Medical Center?
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 in person to apply and paying $20 annual dues. You will be officially voted upon by the membership at your second attendance.

Associate Members (no DXCC at this time) will pay $10 dues. No voting or meeting attendance is required.
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South Florida DX Association