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)