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,

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, for the application form.

* Fields in RED 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:

Grid Square (6 Character) *

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:

Fields in RED must be completed to Submit the form or an error message will be encoutered.

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 paynow button to pay your Dues.

2021 Membership Renewal only for Single or Family Membership:	$10.00
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): Donations go to support of the CDXA club, CDXA Website, and DXPeditions.
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.

Ray Weeks, N4APR
Carolina DX Association
3017 Cutchin Dr.
Charlotte, NC 28208

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