WRCATV Club Membership Registration Form

WRCATV Club Membership Registration

Complete the form below to sign up for our membership service.
Name

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Preferred Phone Number:

Area CodePhone Number
Secondary Phone Number:

Area CodePhone Number
Home E-mail
Do you want to receive our Club Newsletter?
Birth Date:

MonthDayYear
Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!
Which Type of Membership Will You Sign Up With (A Family Membership includes Spouse and any child under 18 that resides with the member)
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Single Membership
Single Membership is for one person aged 18 or Older

$30.00



Family Membership
A Family Membership includes Spouse and any child under 18 that resides with the member

$40.00



Business Membership (Sponsor
For a sponsor membership, $75 is the minimum. You can pay more if you are inclined to do so. If you are signing up for a Sponsor Membership, please submit a business card sized image of your logo or your business card to WRCATVClub@gmail.com.

$100.00



Pay In Person or Mail Payment
Select this option if you plan on mailing your payment to us or if you plan on paying in person. PLEASE CHOOSE YOUR MEMBERSHIP LEVEL IN THE NEXT BOX

Free



Total

$0.00
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If you have selected to pay in person or mail your payment click on debit or credit and your application will be processed.

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WRCATV Club Membership Registration

Which Type of Membership Will You Sign Up With (A Family Membership includes Spouse and any child under 18 that resides with the member)*

If you have selected to pay in person or mail your payment click on debit or credit and your application will be processed.

Which Type of Membership Will You Sign Up With (A Family Membership includes Spouse and any child under 18 that resides with the member)