Carolina DX Association W4DXA

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Online Join/Renew Membership Application Form

For membership RENEWAL ONLY with no changes to your current information, click - - > [ here ] < - -

To Join CDXA or Renew your membership with changes to your current data on file, Please complete the below form then click the correct Paypal Button.

Yearly Dues are $25.00: A second Licensed Amateur family member living in the same household can join for $5.00 for a total price of $30.00 per year. The total price for 3 or more licensed family members living in the same household is only $35.00 per year. All family members will be members.

Complete the below form and follow the instructions, else if you prefer, you can print and complete an application form (pdf) to join or renew your membership by regular mail or giving it to the Secretary/Treasure at a weekly luncheon. If that's your choice, click HERE for the application form.

*Name - First & Last *Call and *Email entries are mandatory. If no Amateur Call enter NONE.
 New Application    Renewal Application    Make Donation to CDXA
 
First Name *:  Last Name *:
Amateur Call *    Call Change No Yes         If Yes, Previous Call
License Class     License Exp. Date
Email Address *
Street or PO Box  
City      State:      Zip Code:
Phone Home     Cell       Work 
Publish Telephone Numbers in Online Roster. Yes  No
Publish Email Address in Online Roster. Yes  No
 
Paying by Paypal, Enter the amount here so we can credit your account correctly.   $

If this is a Family Membership, please complete the Following.

Family Mem  # 2      First Name:     Email:   Publish in Roster. Yes  No
Call:     Lic.. Class:   Lic. Exp. Date:

Family Mem  # 3      First Name:     Email:   Publish in Roster. Yes  No
Call:     Lic. Class:   Lic.Exp. Date:

Family Mem  # 4      First Name:     Email:   Publish in Roster. Yes  No
Call:     Lic. Class:   Lic.Exp.Date:

*Name - First & Last *Call and *Email fields must be completed to Submit Form on line.
Before submitting this form, please enter the characters you see in the image:
Image verification          

After clicking the [Submit Form] button, and no form errors are encountered, a new page, [Thanks! We've received your application] with a [Click Here] to return back to the Application form page ,will open. Click the [Click Here] link to return back here to complete the PayPay information.



Now select the correct buynow button to pay your Dues.

New / Renewal Single Family Membership:                             $25.00
Family membership for 2 members in same household:                   $30.00
Family membership for 3 or more members in same household:       $35.00 
Make a donation to CDXA (optional):      
Make a donation to CDXF a 501(c)(3).:
All donations go to supporting DXPeditions.		  

Clicking one of the Buy Now Buttons will open a secure page on PayPal. On this page you can select a credit card to use or if you have a PayPal account you can use it. Be sure to complete all the information and then click the Review Order and Continue Button. The correct amount is entered by the Button you select.

Bill Fisher, W4GRW
Carolina DX Association
2133 Kirkwood Ave. Apt. #2
Charlotte, NC 28203
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