QUARTER CENTURY WIRELESS ASSOCIATION, INC
Dave Craig, VE6DKC, 8603 – 7 Street SW, Calgary, AB T2V 1G8
(Website –
(Fees Effective Oct. 1, 2012)
I,
(PRINT NAME CLEARLY) (CALL SIGN) (SPOUSE’S NAME & CALL SIGN) – if applicable
have been licensed as an Amateur 25 or more years ago and presently hold the call listed above (it is not necessary to have been licensed the entire 25 years) hereby apply for membership in QCWA. I understand that proof of the original date of licensing is required. My complete mailing address is:
(STREET NUMBER AND NAME)(CITY)(PROVINCE)(P-CODE)
Phone Number: E-Mail Address: Date of Birth:
I will keep QCWA Headquarters advised of changes in my address and or call sign. My first Amateur licence was issued in Other calls held
I wish to become affiliated with QCWA Chapter 151. Birth Place:
Present occupation or business:
If retired, what was major life work?
Other organizations you belong to:
Brief outline of your radio activities:
Proposed by: Call Membership No:
Date:Your Signature:
To save on printing and mailing costs would you be willing to receive via e-mail (if applicable) all Chapter 151 information bulletins, notice of meetings, meeting minutes and other information? YES: NO:
SCHEDULE OF MEMBERSHIP FEES
(Canadian Members – Canadian Funds)
Select one of the following plansMembersFamily
QCWA Fee - 1 Year (Digital eJournal) incl. 3 yr. Chapter 151$ 52.00$ 35.00
QCWA Fee – 2 Year (Digital eJournal) incl. 3 yr. Chapter 151$ 67.00$ 42.00
QCWA Fee – 3 year (Digital eJournal) incl. 3 yr. Chapter 151$ 82.00$ 47.00
QCWA Life Member (Digital eJournal) incl. 3 yr. Chapter 151$ 530.00$187.00
Initial Registration Fee – (New Members Only)- $7.00
DONATIONS (with thanks)
Gold membership pins are available with your call sign engraved. No year tags. Check below fastener type.
Tie Tac Screw Button Safety Pin$ 22.00 each
Year Tag pins - 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75 years – tie-tac only $ 28.00 each
(Make Cheque Payable to QCWA Chapter 151 and mail to above address) GRAND TOTAL