Postal Address:

Tri-County Amateur Radio Club Inc.
99 Avalon Street
Dieppe, New Brunswick E1A 1J8

Email Address: ve9tca@rac.ca

Membership form

Check One:   [ ] New Membership [ ] Membership Renewal [ ] Change of Information
20$ Yearly

Date: ____________________

Name: _______________________________ Callsign: _____________________

Address: __________________________________________________________________

City: _____________________ Province: _____________ Postal Code: ______________

Phone (day): ___________________ Phone (evening): ___________________________

Cell: ________________________

Email: ____________________________________________________________________

Date first licensed: _________________________ Class of license: ___________________

RAC Member:  Yes/No.  RAC Membership Number: _____________

ARES Volunteer:  Yes/ No

Please mail cheque and membership form to address above.