MDARC Membership-2024

Personal Information

• * First Name:
• * Last Name:
• * Call Sign (Enter SWL if none)

• If this is a Gift Membership, see the Gift membership section below before filling in these two Email Address fields.

• * Email Address:
• * Confirm Email Address:

• If your USPS mailing address or phone number(s) have changed please enter your new information below. Please enter information here ONLY if it has changed.

• Address 1:
• City:
• State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• ZIP Code:
• Phone:
• Cell Phone:

• Fee

  Type	Fee
  Membership Dues including Carrier newsletter via e-mail	$45.00
  Student Member Dues including Carrier newsletter via e-mail	$15.00

Family Member Information

You may add a maximum of 4

Additional Information:

• Membership Card: If you would like to have a new membership card mailed to you, please send a SASE to: Membership Chair, Mount Diablo Amateur Radio Club; Post Office Box 23222; Pleasant Hill , CA 94523-0222.

• Are you an ARRL member? This is important to maintain MDARC's Special Service Club status with the ARRL.

  • Yes, I'm an ARRL member.
  • Yes, I'm an ARRL LIFE member,
  • No, I'm not an ARRL member.

Gift Membership

• If you would like to give this membership as a gift to someone else, please fill in the above "Personal Information" fields with the recipient's information; and the below fields with your own. If you would like the gift to be anonymous, enter YOUR OWN email address in the above two ("Email Address" and "Confirm Email Address") fields and the recipient's email address in the Contact Information field below. This difference is for the email address only. (Yes, this seems backwards, but it will prevent the automatically-sent confirmation message from spoiling your surprise. You will get it instead of the recipient.)

• Is this a Gift Membership for another person?

  • Yes
  • No
• Gift-giver's Name:
• Gift-giver's Callsign (if any):
• Gift-giver's contact information (email or phone no.):