WRCC   MEMBERSHIP   APPLICATION


Mail to:                                                                            Email to:    secretary@waterwayradio.net

           Waterway Radio & Cruising Club

           27 Cheyenne Court,       Palm Coast, Florida 32137-8966

 

 

Amateur Call Sign                              Class                Nickname                                                      

 

Mate’s  Call Sign                                Class                Nickname                                                      

 

First Name (s)                                                                                                                               

 

Last Name (s)                                                                                                                               

 

Mailing Address                                                                                                                                

 

City                                                       State                                       Zip                       -             

 

Home Phone                                                                  Fax                                                

 

May we publish your home phone in the roster?  Yes                  No               

           

Other Phone                                                                            Is this a cellular Phone                        

 

May we publish your cell phone in the roster?      Yes                  No               


E-mail address No. 1:                                                           No. 2:                                                 

 

Boat Name                                                                                                                                       

 

Boat Description                                                                                                                           

                                    Make, Model, Length, rig if sail/type if power

            Examples: Morgan Out-island 41’ ketch; Grand Banks 42’ trawler

 

Are you a volunteer examiner?  ARRL                            (and/or)  W5YI              

 

Seasonal address: (for alternate mailing of newsletter or roster – not published)

 

Mailing Address                                                                                                                                

 

City                                                       State                                       Zip                       -               

          

Time frame                                                                                                                                       

           

Skills/Interests (Doctor, Vet, computers, antennas, radio repair, delivery skipper, etc)

 

                                                                                                                                                           

 

Amount Enclosed:  (Prices in [brackets] are for mailings to other than the US and Canada)

 

Dues:  U.S. and Canadian addresses $16.00 ;   [Other countries $21.00]                                 

(Note: Add $.75 if paying by PayPal)

 

                Heavy duty burgee  $15.00                               

 

                 

Sunshine Fund contribution (completely voluntary - for flowers and cards

        to members and/or family who are ill, recovering, silent keys, etc)                                     

 

                                                                                                                Total