Update Personal Profile Data

Use this form to update your CDXA membership record at any time when your email, call, home address, etc. change. If your call has changed, give both your new call then your old call.

*Name - First & Last *Call and *Email entries are mandatory
 
Given  Name *        Last Name *:
Amateur Call *          Call Change No Yes         If Yes, Previous Call
License Class           License Exp. Date
Email Address *   
Street or PO Box  
City      State:      Zip Code:
Phone Home     Cell       Work 
Publish Telephone Numbers in Online Roster. Yes  No
Publish Email Address in Online Roster. Yes  No
 
 
        Enter your comments or other information here.
        

*Name - First & Last *Call and *Email fields must be completed to Submit Form on line.
Before submitting this form, please enter the characters you see in the image:
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Cliff Wagoner, W3ZL
Carolina DX Association
P.O. Box 577
Davidson, NC 28036
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