COOKEN Membership Application

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Name  
Call
License Class
Street Address
Address (cont.)
City
County
State
Zip Code
Home Phone
E-mail
URL

ARRL Member?   Yes  No  If Yes, are you a Life Member?

ARES Member?   Yes  No  If Yes, which organization?

MARS Member?   Yes  No  If Yes, which organization? Army Air Force Navy

VE?                    Yes  No

Interest             CW  FM Data SSB Mobile Packet QRP Contesting DXingComputers Satellites SSTV

Bands                HF   6m 2m  1 1/4M 70cm 

Check the type of membership requesting:

Full Membership (Full membership is open to all licensed amateurs and includes all club privileges as well as rights to hold club office and to vote for club officers.)

Family Membership (There will be a 50% reduction in dues for each additional member in a multi-ham family. List other family members below:

         Name:    Call:    ARRL Member

         Name:    Call:    ARRL Member

         Name:    Call:    ARRL Member

Student Membership (Any COOKEN member still in school (high school or college) is entitled to a 50% reduction in dues. This can not be combined with the family reduction above.

Associate Membership (Associate membership is open to those actively engaged in a class leading to an Amateur Radio license and all other interested persons. Associate members are not required to pay dues during the remainder of their first club calendar year of membership. Associate membership includes all club privileges except for the right to hold office and to vote for club officers.)

Dues are $1.00 per month, per member. Dues for all regular members shall be payable to the Treasurer on a yearly basis during the first quarter of each club year (July-Sept) and prorated monthly for those joining after July 1. Please pay, in cash, at the first meeting you attend.

After you have filled out the form, print the page and bring it with you to our next meeting. 

You may also print it out a blank copy of form in pdf format, fill it out by hand, and submit it that way.