------------------------------------
                      REDXA MEMBERSHIP APPLICATION/RENEWAL
                      ------------------------------------
Note:  Dues ($20/year) are due by January 1 each year; prorated for new members

NAME_______________________________ CALL______________DATE__________________

Address__________________________________Class______________________________

City____________________________________, CA.   Zip Code____________________

Telephone  (home) ____________________________ (work) ______________________

EMail Address_______________________________________Fax Number______________
-----------------------------------------------------------------------------
Station Equipment:

     HF _______________________________ Amplifier ___________________________

     Antennas___________________________________________________Height_______

     VHF/UHF____________________________Packet TNC___________________________

     RTTY__________________________ Other ___________________________________

Mobile Equipment:____________________________________________________________

Hand Held Tranceiver ________________________________________________________
------------------------------------------------------------------------------
General Information:

     What other radio organizations do you belong to:

     ARRL_____NCDXC______SCRA_____MARC_____NCCC______ OTHER__________

     Are you interest in contests:________

         Which ones?__________________________________________________________

     Number of DXCC countries confirmed:

         Mixed__________________Phone ______________CW_________RTTY___________

     Are you interested in upgrading your license?____________________________

     Areas I would like to learn more about: _________________________________

     _________________________________________________________________________

     Special interest and/or skills I could share with REDXA
     members:       

     _________________________________________________________________________

     _________________________________________________________________________
    
     Suggestions for club improvement:

     _________________________________________________________________________