Chippenham & District Amateur Radio Club – Application Form Please complete the application form below and press submit, so that we can process your application. If you already hold an Amateur Radio Licence, what is your callsign? First Name: Surname: Your postal address: Your postcode: Your Email Address: I am happy to receive the club newsletter by email Your Home Telephone Number: Your Mobile Telephone Number: I hereby apply to become a member of Chippenham & District Amateur Radio Club for a period of 12 months, subject to the approval of my application by the committee. I understand and I agree to the Club's Constitution. I am over the age of 16 years of age. NOTE: Your membership will not be processed until you complete the payment process on the next page. Click the PROCEED button below, and you will now be directed to PAYAL. Once your payment has been successfully completed you will be returned to our website and will receive a confirmation message confirming your Membership.