APPLICATION FOR CIC MEMBERSHIP

CHAPTER HEAD

STEWART H STONE

5259 COLUMBUS PL

Oxnard, Ca 93033

LOG EXAMPLE

CALLSIGN---1010 NR/CIC IQ-----FIRST NAME-----STATE---DATE 1._________________________________________________________ 2._________________________________________________________ 3._________________________________________________________ 4._________________________________________________________ 5._________________________________________________________

Your log must be in the order as shown above and 2 of the 5
qso's must be an IQ, or Instant Qualifier.

Mail your logs with proof of current 1010 dues, (A photo copy
of your 10x membership card will suffice)with $5.00(US)
to the Chapter Head above. Although this application
is accepted via email, your member ship dues must
be sent regular mail as well as all
Award Applications.

Name:______________________________________
Address:___________________________________
City:_______________________State:___________
Zip Code:____________Phone:__________________
Callsign___________1010-NR__________VP NR________
Include "Proof" of current dues.____________
Usually copy of 10x card

EMAIL OPTION

COPY APPLICATION TO CLIPBOARD (CTRL "C").
OPEN IN EDITOR (NOTEPAD) FILL OUT AND
SAVE AS (APP), PRINT, THEN MAIL.

LAST UPDATE 6 APRIL 2005

E-Mail APPLICATION to KG6BOV.

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