Clone of SFDXA 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

Other Awards Earned:

Operating Bands

Modes

Activities

Service Interests

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?

Which Membership Type are you Requesting? (See descriptions below)

Enter the message as it's shown

Full Membership (I have a DXCC or verified 100 countries confirmed) 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. on site or by Zoom.

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

Dues are payable by PayPal at the email address of payments@sfdxa.com. No paypal account is necessary and be sure the entity you are paying comes up as South Florida DX Associaton.

The South Florida DX Association is a "NOT FOR PROFIT" Florida corporation, affiliated with the ARRL.