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 $20.00 ;   [Other countries $25.00]     

(Note: Add $1.00 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