Carolina DX Association W4DXA

Online Join Membership Application Form

For 2024 membership RENEWAL ONLY with no changes to your current information, Click Here

To Join CDXA or Update your Membership Profile Information with changes to your current data on file, Please complete the below form then click the correct Paypal Button.

Yearly Dues are $15.00: For a second Licensed Amateur family member living in the same household the total price is $20.00 per year. For 3 or more licensed family members living in the same household the total price is $25.00 per year.

Complete the below form and follow the instructions, else if you prefer, you can print and complete an application form (pdf) to join or renew your membership by regular mail or giving it to the Secretary/Treasure at a weekly luncheon. If that's your choice, Click Here for the application form.

* Fields in RED are mandatory. If no Amateur Call enter NONE.

New Application    Update my Information    Make Donation to CDXA

First Name *:  Last Name *:

Amateur Call *    Call Change No Yes         If Yes, Previous Call License Class   Extra Advanced General Tech Plus Technician Novice None     License Exp. Date

Email Address *

Street or PO Box

City      State: North Carolina South Carolina 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 Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other      Zip Code:      Country:

Grid Square (6 Character) *

Phone Home     Cell       Work

Publish Telephone Numbers in Online Roster. Yes  No Publish Email Address in Online Roster. Yes  No

Paying by Paypal, Enter the amount here so we can credit your account correctly.   $

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If this is a Family Membership, please complete the Following.

Family Mem  # 2

First Name:     Email:   Publish in Roster. Yes  No Call:     Lic.. Class:   Extra Advanced General Tech Plus Technician Novice None   Lic. Exp. Date:

Family Mem  # 3

First Name:     Email:   Publish in Roster. Yes  No Call:     Lic. Class:   Extra Advanced General Tech Plus Technician Novice None   Lic.Exp. Date:

Family Mem  # 4

First Name:     Email:   Publish in Roster. Yes  No Call:     Lic. Class:   Extra Advanced General Tech Plus Technician Novice None   Lic.Exp.Date:

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Fields in RED must be completed to Submit the form or an error message will be encoutered.

Before submitting this form, please enter the characters you see in the image:
         

After clicking the [Submit Form] button, and no form errors are encountered, a new page, [Thanks! We've received your application] with a [Click Here] to return back to the Application form page will open. Click the [Click Here] link to return back here to complete the PayPay information.

If using the form to update your profile information you do not need to complete the paypal section.

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Now select the correct button to pay your Dues.

Clicking one of the Buy Now Buttons will open a secure page on PayPal. On this page you can select a credit card to use or if you have a PayPal account you can use it. Be sure to complete all the information and then click the Review Order and Continue Button. The correct amount is entered by the Button you select.