Please print out this page, fill it in and mail it with payment as instructed below.
| Name: | |
| Address: |
|
| Tel. (include country code and area code): |
|
| E-mail: | |
| May we print your name & address in our new members section and in our membership list? | Yes: ______ No: ______ |
The following questions are optional. They help to give us an idea of your interests.
| Age: | Years in the radio hobby: | ||
| Married or Single: | Occupation: | ||
| Equipment used: Receivers: |
Transmitters: | ||
| Antennas: | Accessories: |
| How did you hear about CIDX? | |
| What other radio clubs do you belong to? | |
| Please indicate your prime areas of radio interest: (Shortwave, AM, FM/TV, LW, VHF/UHF, Utilities, Clandestine, Pirate, QSLs, Ham, CB, Other) | |
| Callsign: (if you are an amateur (ham) operator) | |
| Do you own a scanner? ____ Model: | |
| Do you own a computer? ____ Model: | |
| What other hobbies interest you? |
Please mail completed application, with cheque (Canada & US only), money order, or
bank draft payable to Canadian Int. DX Club, to:
Canadian International DX Club
P.O. Box 67063-Lemoyne
St. Lambert, Quebec
CANADA J4R 2T8