2020 Membership Business event registration

First Name *

Last Name *

CallSign or N0CALL if you are unlicensed *

Grid Square

Address *

City *

State *

Zip *

Phone *

Email *

Are you an ARRL member?

Yes

No

Are you a CSVHFS Life Member?

Yes, I am a CSVHFS Life Member (deducts the $5 annual dues)

No, I am not a CSVHFS Life Member

Membership *

Yes, I would like to become a CSVHFS annual member ($0)

No, I do not wish to purchase a CSVHFS annual membership ($0)

Life Membership *

Yes, I would like to become a CSVHFS life member ($120)

No, I do not wish to purchase a CSVHFS life membership ($0)

Donation

Coupon

Amount

$

Discount Amount

$

Gross amount

$

Payment Method *

Paypal Offline Payment - Submit via mail

Billing Zipcode*

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Type*

Card Holder Name*

Verification code*

Individual Registration