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 enjoy the following aspect/s of the hobby:
Using the club radios & mastFurthering my skills / TrainingSocial Activities (non radio)Contesting (excluding Field days)Contesting (Field days)Organised visits/tripsFilm NightsSpecialist Talks/PresentationsBuilding kit / ElectronicsRegular radio netsWorking with Scouts/JOTA etcTraining others

I hereby apply to RENEW my membership of Chippenham & District Amateur Radio Club for a period of 12 months.
I understand and I agree to the Club's Constitution.